剖宫产术后镇痛对乳汁分泌及新生儿的影响

Effect of analgesia after cesarean section on milk-secretion and neonates

目的:测定剖宫产术后镇痛产妇乳汁、血清、尿液及新生儿尿液中镇痛药物含量,观察术后镇痛对乳汁分泌和新生儿的行为的影响。方法:选择88例足月妊娠剖宫产产妇,随机分为3组,曲马多静脉镇痛组(A组,n=34),吗啡硬膜外镇痛组(B组,n=34),空白对照组(C组,n=20)。采用高效液相色谱仪和质谱仪测定剖宫产术后24 h产妇乳汁、血清和尿液中以及新生儿尿样中镇痛药物含量。观察产妇开始泌乳和新生儿开始睁眼时间,记录48 h新生儿哺乳次数、呼吸和心率。结果:A组术后乳汁中未能检测出曲马多含量,34例新生儿术后24 h尿样中有3例检测出曲马多,检出率仅为8.82%。B组34例产妇乳汁中有7例检测出吗啡,检出率仅为20.6%,34例新生儿尿样中有3例检测出吗啡,检出率仅为8.82%。与C组相比,A、B两组产后开奶时间、泌乳时间和哺乳次数均有显著性差异(P<0.05);A、B两组新生儿的呼吸、心率和睁眼时间均无显著差异(P>0.05)。结论:剖宫产术后镇痛能促进乳汁分泌,镇痛药物吗啡和曲马多都能通过乳汁进入新生儿的体内,但进入新生儿体内的药量甚微,达不到有效血药浓度,故对新生儿无不良影响。

Objective:To detect the contents of analgesic drugs in maternal breast milk,serum,and urine after cesarean section and neonatal urine,and observe the effect of postoperative analgesia on milk-secretion and neonates.Methods:A total of 88 full-term parturient women after cesarean section were selected and randomly divided into three groups: 34 women in group A were treated with intravenous drip of tramadol for postoperative analgesia,34 women in group B were treated with epidural application of morphine,and 20 women in group C were designed as blank control group.High performance liquid chromatograph(HPLC) and mass spectrometer were used to detect the contents of analgesic drugs in maternal breast milk,serum,and urine at 24 hours after cesarean section and neonatal urine.The initial lactation time of parturient women and initial time for eye opening of neonates were observed;the times of lactation,respiration rate,and heart rate of neonates at 48 hours after birth were recorded.Results:The content of tramadol in breast milk after cesarean section in group A couldn't be detected;among 34 neonates,tramadol was detected in urine of 3 neonates at 24 hours after birth,the detection rate was only 8.82%.Among 34 parturient women,morphine could be detected in breast milk of 7 women at 24-48 hours,the detection rate was only 20.6%;among 34 neonates,morphine could be detected in urine of 3 neonates,the detection rate was 8.82%.Compared with group C,there were statistically significant differences in initial lactation time,lactation time,and the times of lactation between group A and group B(P<0.05);there was no statistically significant difference in respiration rate,heart rate,and initial time for eye opening of neonates between group A and group B(P>0.05).Conclusion:Analgesia after cesarean section can promote milk-secretion,both morphine and tramadol can enter the body of neonates through breast milk,but the doses are minimal and can't achieve effective blood concentration,so they have no impact on neonates.