剖宫产术后两种镇痛方法对产妇泌乳及产后恢复的影响

Effects of Two Kinds of Analgesia Methods on Plasma Prolactin and Colostrum Time in Parturi-ents After Cesarean Section

【目的】探讨剖宫产术后两种阵痛方法对产妇泌乳及产后恢复的影响。【方法】分析2008年1月至2010年12月本院收治的120例健康足月产妇择期在联合椎管内麻醉下施行剖宫产术的临床资料。术后在知情同意的原则下，按镇痛方式的不同，随机分为行0．2％罗比卡因（5 mL／h）的硬膜外自控镇痛（PCEA）组（A组）和曲马多10 mg／kg ＋氟哌利多5 mg 的静脉自控镇痛（PCIA ）组（B组），每组60例。两组均持续48 h镇痛。观察产妇血浆泌乳素（PRL ）水平、初乳时间、肠蠕动恢复时间及并发症发生情况。【结果】两组术后PRL 水平均较术前明显升高（ P ＜0．01），A组PRL高于B组，术后24 h有显著性差异（ P ＜0．05），48 h有极显著性差异（P ＜0．01）。A组初乳时间、肠蠕动恢复时间较B组均提前（P ＜0．05），A组术后生命体征平稳，无恶心呕吐、头痛、肢体麻木发生，B组术后有5例出现恶心呕吐、头痛、盗汗现象，无其他不适。【结论】剖宫产术后罗比卡因PCEA镇痛效果确切安全，更能促进PRL分泌，有利于产妇泌乳，哺乳。

[Objective] To explore the effects of two kinds of analgesia methods on plasma prolactin（PRL） and colostrum time in parturients after Cesarean section .[Methods]Totally 120 healthy full‐term parturients in our hospital from Jan .2008 to Dec .2010 underwent elective Cesarean section under the combined intraspinal anesthesia .Under the informed consent after operation ,all patients were randomly divided into patient‐con‐trolled epidural analgesia（PCEA） with 0 .2% ropivacaine（5mL/h） group（group A ,n=60） and self‐controlled intravenous analgesia（PCIA） with tramadol 10mg/kg and droperidol 5mg group（group B ,n=60） .The anal‐gesia lasted for continuous 48h .Plasma prolactin（PRL） ,colostrum time ,enterocinesia recovery time and com‐plications of parturients were observed .[Results] Compared with before operation ,PRL level in two groups after operation was obviously increased （ P〈0 .01） .PRL level in group A was higher than that in group B , and there was significant difference 24h after operation（ P 〈0 .05） ,and there was very significant difference 48h after operation（ P〈0 .01） .Colostrum time and recovery time of enterocinesia in group A were earlier than those in group B（ P〈0 .05） .In group A ,the vital signs were stable ,and no nausea and vomiting ,head‐ache and numbness of the limbs occurred .In group B ,5 patients had nausea and vomiting ,headache and swea‐ting phenomenon after operation ,but had no other discomfort .[Conclusion] PCEA with ropivacaine after Ce‐sarean section has certain analgesia effect ,and can more promote the secretion of PRL ,and is helpful for lacta‐tion and breast feeding .