不同分娩及镇痛方式对产妇泌乳及新生儿的影响

Effects of different ways of delivery and analgesic on maternal postpartum galactosis and newborns

目的探讨剖宫产及术后不同镇痛方式的镇痛效果，并与阴式分娩比较其对产妇泌乳及新生儿的影响。方法住院分娩的孕产妇150例，根据分娩方式及手术后镇痛方式不同分为5组，每组30例。A、B、C、D组为剖宫产者，均采用腰一硬联合麻醉，术毕，A组采用硬膜外连续微量泵镇痛，B、C、D组采用静脉微量泵镇痛，4组的配方药中均加入氟哌利多5mg，0．9％氯化钠溶液稀释至100mL，术后持续镇痛48h。镇痛药物配伍，A组：芬太尼0．3mg＋0．75％布比卡因15mL；B组：芬太尼1．3mg；C组：芬太尼1．3mg＋地佐辛10mg；D组：芬太尼1．3mg＋地佐辛15mg。E组为阴道自然分娩，未采用镇痛。随访记录产（术）后48h内镇痛效果、不良反应、泌乳及母乳喂养情况，检测产前产后不同时间血清泌乳素水平、新生儿Apgar与NBNA评分等情况。结果剖宫产4组的疼痛评分，术后4h内差异不大，术后8-48h，各组疼痛评分差异均有统计学意义（P〈0．05），由低到高呈现D、C、B、A的趋势。不良反应，A组主要是硬膜外导管脱落、寒战、下肢麻木不适等，B、C、D组主要是恶心呕吐、头晕、皮肤瘙痒等，其合计发生率的组间差异无统计学意义（P〉0．05）。产后开始泌乳时间、母乳量充足时间、7d纯母乳喂养率、血PRL水平、新生儿Apgar评分及3d神经行为评分（NBNA），各组差异均无统计学意义。结论剖宫产术后镇痛效果以D、C组为最优，剖宫产及所采用的几种术后镇痛方法对产妇泌乳、新生儿健康及神经行为未见明显影响。

Objective To explore the analgesic effects of cesarean section and different postoperative analgesia method and to investigate the influence of maternal postpartum galactosis and newborn,compared with the vaginal delivery. Methods 150 cases hospi- talized delivery of maternal were included, according to the delivery method and analgesia methods divided into five groups, 30 cases in each group. A, B, C, D groups for cesarean delivery, used the lumbar subarachnoid anesthesia and epidural anesthesia methods. After the surgery,continuous epidural analgesia was used in group A. B, C and D. Prescription drugs of analgesia pump were given droperidol 5 mg plus 0.9% sodium chloride solution diluted to 100 mL, postoperative analgesia were continued 48 hours. Analgesic drug compatibility in group A：fentanyl 0.3rag plus O. 75% bupivacaine 15 mL;Group B：fentanyl I. 3 mg;Group C：fentanyl 1.3 mg plus dezocine 10 mg; Group D ：fentanyl 1.3 mg plus dezocine 15 mg. Group E was vaginal natural childbirth,analgesia pump was not used. Recorded the anal- gesia effect, adverse reactions,postpartum galactosis and breastfeeding, different period of prenatal postpartum serum prolactin level, neo- natal Apgar score, NBNA score, and so on within 48 hours. Results Compared the pain scores of cesarean section groups, there were sta- tistically difference in 4 hours,8 - 48 hours after surgery （P 〈 0.05 ）. There had a trends of D, C, B, A. Adverse reactions, in group A, the adverse reactions included epidural catheter shedding, chills, lower limbs numbness discomfort. B, C, D group included nausea and vomiting, dizziness, skin pruritus. There was no statistically difference between the groups （ P 〉 O. 05 ）. And the time of postpartum lacta- tion, the time of breasffeeding enough,7 days exclusive breastfeeding rate, blood PRL level and neonatal Apgar score and neurobehavioral score （NBNA） in 3 days,there were no statistically differences between groups （P 〉 O. 05 ）. Conclusion The analgesia effects after ce- sarean section in D and C group are best than others. Cesarean section and the analgesia methods have not obviously influence for post- partum lactation, neonatal health and neural behaviors.