剖宫产术对母乳喂养影响的前瞻性研究

Prospective observational study on the effec ts of caesarean section on breastfeeding

目的研究剖宫产术对母乳喂养的影响.方法采用前瞻性研究方法,选择剖宫产（剖宫产组）、阴道分娩（阴道分娩组）各301例产妇为研究对象,比较两组产妇产后泌乳始动时间、产后1年内母乳喂养情况;用放射免疫法测定两组产妇产后血清催乳素含量.结果在分娩后6～24 h内的白天,剖宫产组产妇血清催乳素均值为8.48 nmol/L（95%CI：7.80～9.21 nmol/L）、阴道分娩组为9.61 nmol/L（95%CI：8.99～10.26 nmol/L）.剖宫产组产妇产后泌乳始动中位时间为产后12 h,晚于阴道分娩组的产后2 h.剖宫产组产妇产后1个月时乳量仅为阴道分娩组的90%.产后1、6、12个月时,剖宫产组母乳喂养率均低于阴道分娩组;剖宫产组产妇产后1年内母乳喂养失败的风险是阴道分娩组的1.21倍（95%CI：1.10～1.33）. 结论与阴道分娩组比较,剖宫产术后产妇泌乳始动时间晚,血清催乳素含量低,产后1年内母乳喂养失败的风险高.对剖宫产产妇更应加强促进泌乳、催乳的措施,以提高母乳喂养成功率.

Objective To study the effects of caesarean section on breastfeeding. Methods Six handred and two [301 cases was caesarean section （caesarean section group） and 301 cases was vaginal delivery （vaginal delivery group） ] nulliparas were interviewed face-to-face at antepartum and postpartum in an indication-matched prospective study. Results There was a significantly lower postpartum prolactin （PRL） level in the caesarean section group （8.48 nmol/L, 95% CI： 7.80-9. 21 nmol/L） compared with vaginal delivery group （9. 61 nmol/L, 95%CI：1：8.99 - 10. 26 nmol/L） during 6-24 hours in the daytime after delivery. The median time of breastfeeding initiation was 12 hours and 2 hours after birth for caesarean section and vaginal delivery groups respectively. Caesarean section was an important hazard for a shorter duration of breastfeeding （RR=1.21 ; 95% CI： 1.10-1.33 ） within one year after childbirth. Conclusions Caesarean section is associated with significantly lower postpartum PRL, which is in line with the longer breastfeeding initiation and lower rate of successful breasffeeding. Necessary measures including promoting the secretion of postpartum PRL such as early contact, early sucking and analgesic method should be taken to improve the successful breasffeeding rate.