术后镇痛对剖宮产术后母乳喂养及新生儿的影响

Effects of postoperative analgesia on breast feeding and neonatal neurobehavioral scores after caesarean section

目的研究剖宮产术后不同镇痛模式对母乳喂养及新生儿神经和适应能力评分(NACS)的影响。方法120例单胎足月妊娠拟行剖宮产的产妇,采用持续硬膜外麻醉。依术后镇痛用药不同,随机均分为四组。Ⅰ组:0.2%甲磺酸罗哌卡因;Ⅱ组:吗啡80μg/h+0.2%甲磺酸罗哌卡因;Ⅲ组:芬太尼3μg/h+0.2%甲磺酸罗哌卡因;Ⅳ组:术后疼痛时采用盐酸哌替啶肌注作为对照。Ⅰ～Ⅲ组均采用镇痛泵,负荷量为0.2%甲磺酸罗哌卡因5ml。记录术后2、6、24、48h的疼痛视觉模拟(VAS)评分,观察恶心、呕吐等不良反应发生情况;随访术后24h内及术后6w母乳喂养情况;记录术后24h内新生儿NACS。结果Ⅰ组术后24、48hVAS评分高于Ⅱ、Ⅲ组(P<0.05),Ⅳ组术后各时点VAS评分均高于Ⅱ、Ⅲ组(P<0.05),且术后2、6hVAS评分高于Ⅰ组(P<0.05)。术后24h内及术后6w母乳喂养情况以及术后24h内新生儿NACS各组差异无统计学意义。结论吗啡或芬太尼复合甲磺酸罗哌卡因持续硬膜外镇痛均可有效用于剖宮产产妇术后镇痛,对新生儿和母乳喂养无不良影响。

Objective To evaluate different analgesia techniques on breast-feeding and neonatal neurological and adaptive capacity scores（NACS） after cesarean section. Methods One hundred and twenty term parturients after cesarean section under epidural block were randomly assigned into four groups with 30 cases each. The patients in group I received epidural analgesia with 0. 2% ropivacaine mesylate,those in group Ⅱ with 80 μg/h of morphine and 0. 2% ropivacaine mesylate, and those in group Ⅲ with 3μg/h of fentanyl and 0. 2% ropivacaine mesylate. Group Ⅳ was given conventional postoperative analgesia with meperidine injection. The visual analog scales（VAS） and the adverse effects were observed at 2,6,24 and 48 h after operation. The breast feeding during 24 h and 6 weeks after operation and NACS was recorded at corresponding time points. Results The VAS was significantly higher in group I than that in group Ⅱ or Ⅲ at 24 and 48 h（P〈0. 05）. The VAS was significantly higher in group IV than that in group Ⅱ or Ⅲ group at all time points and than that in group I at 2 and 6 h after operation（P〈0. 05）. There was no significant difference in breast feeding and NAGS among the 4 groups. Conclusion Morphine or fentanyl combined with ropivacaine mesylate for epidural analgesia in parturients after cesarean section can provide an effective analgesia without adverse effects on breast-feeding and NACS.