剖宫产术后经静脉芬太尼自控镇痛对催乳素的影响

Influence of intravenous patient controlled analgesia with fentanyl on plasma concentration of prolactin in parturient after cesarean section

目的 观察剖宫产术后芬太尼静脉自控镇痛对血浆催乳素浓度的影响。方法 2 1例择期行剖宫产术孕妇 ,随机分成镇痛组 (n =11)和对照组 (n =10 )。镇痛组在剖宫产术后 ,采用病人自控静脉镇痛 (PCIA)给予芬太尼 ,芬太尼持续剂量 10～ 15 μg·h-1,PCA剂量为 10 μg ,1h限量 130 μg ,镇痛时间 2 4h。采用放射免疫法测血浆催乳素 (PRL)浓度 ,视觉模拟评分法 (VAS)估计镇痛效果。结果 镇痛组VAS明显低于对照组 (P <0 0 1) ;镇痛组初乳时间明显早于对照组 (P <0 0 5 ) ;两组病人术后 2 4h血浆PRL浓度明显高于术前 (P <0 0 1) ,镇痛组的术后 2 4h血浆PRL明显高于对照组 (P <0 0 5 ) ,镇痛组术后心率、血压平稳 ,无皮肤搔痒、呼吸抑制及呕吐发生。结论 剖宫产术后采用芬太尼PCIA ,镇痛效果确切安全 ,能增加PRL分泌 ,使初乳提前 。

Objective To observe the effects of intravenous patient controlled analgesia(PCIA) with fentanyl on plasma prolactin level after cesarean section Methods Twenty one parturients having undergone elective cesarean section under epidural anesthesia, were randomly allocated to PCIA group (n=11) and control group (n=10) In PCIA group, intravenous fentanyl was administered at rate of 10 15 μg h -1 with the PCA bolus dose of 10 μg and maximum dose of 130μg in one hour, and in control group without postoperative analgesia The plasma prolactin levels was determined with radioimmunossay The analgesic efficacy was evaluated with visual analog scale (VAS) Results In PCIA group the VAS score was significantly lower and the colostrum secretion was more early than those in control group (P<0 05 or 0 01) The plasma levels of prolactin of both groups increased markedly 24h after cesarean section compared with those before surgery (P<0 05) The plasma prolactin level was obviously higher in PCIA group 24h after cesarean section than control level Heart rate and blood pressure were kept stable during whole procedures without respiratory depression and vomiting Conclusion Intravenous patient controlled analgesia with fentanyl is not only safe and effective for postoperative analgesia after cesarean section ,but also increase the prolactin secreation to improve maternal colostrum