左布比卡因术后镇痛对剖宫产术后产妇泌乳素的影响

Effects of L-Bupivacaine epidural analgesia on secretion of prolactin after cesarean section

目的探讨左布比卡因硬膜外镇痛对剖宫产术后产妇泌乳素的影响。方法选择足月单胎妊娠剖宫产产妇120例,随机分为患者自控硬膜外镇痛泵(PCEA)组、自控静脉镇痛泵(PCIA)组和哌替啶肌肉注射镇痛(PMA)组,各40例。PCEA组选用左布比卡因经患者自控性硬膜外镇痛泵给药;PCIA组选用叮丙诺啡经患者自控性静脉镇痛泵给药,PMA组选用哌替啶,在患者疼痛时肌肉注射。3组均用放射免疫分析法测定血浆泌乳素浓度,采用伤口疼痛视觉模拟评分(VAS)测定镇痛效果。结果组间相比,PCEA组的镇痛效果明显优于PCIA组和PMA组(分别为P<0.05和P<0.01);PCEA组血浆泌乳素水平明显高于PCIA组和PMA组(分别为P<0.05和P<0.01);PCEA组初次泌乳时间早于PCIA组(P<0.05)和PMA组(P<0.01)。结论左布比卡因用于剖宫产术后硬膜外镇痛效果满意,可提高血浆泌乳素水平,增加乳腺分泌乳汁,有利于新生儿母乳喂养,同时其镇痛效果优于静脉镇痛,显著优于肌肉注射哌替啶。

Objective To investigate the effect of L-Bupivacaine epidural analgesia after cesarean section on secretion of prolactin. Methods 120 full-term pregnant women undergoing cesarean section were randomly divided into three groups, patient controlled epidural analgesia （ PCEA ） group, patient controlled intravenous analgesia （ PCIA ） group and petMdine muscle analgesia （ PA ） group, with 40 patients in each group. The plasma prolactin concentration was determined by ILIA and the degree of analgesia were investigated according to VAS, Results The levels of prolactin in 24hr and 48hr post-operation were significantly higher in PCEA group than those in PCIA group （ P 〈 0.05 ） and PMA group （ P 〈 0.01 ）. Conclusion The L-Bupivacaine epidural analgesia after cesarean section might be the better choice for lightening post-oporative pain and improving secretion of Pprolactin.