剖宫产术后早期不同时段乳房按摩对产妇泌乳情况的影响

The effect of breast massage at different time in the early period after cesarean section

目的 调查剖宫产术后早期不同时段乳房按摩对产妇泌乳情况的影响。方法 采用随机区组设计，将2013年1月至2015年1月山东省某医院产科病房80名剖宫产术后产妇分为4组，每组各20名，其中3组分别于术后2、12、24 h进行乳房按摩，每隔24 h重复1次，共进行3次，对照组不进行乳房按摩。术后即开始观察记录各组泌乳始动时间和乳汁分泌状况。分别于术前2 h、术后6、12、24、48、72 h采集对象静脉血5 ml，测定血清泌乳素含量。对各组产妇的泌乳情况进行比较。结果 术后2、12、24 h按摩组和对照组的泌乳始动时间P50（P25-P75）依次为3（2-6）、4（2-8）、4（3-12）和4（2-12）h，差异无统计学意义（H=3.32，P=0.345）。术后2 h按摩组和对照组术后24 h泌乳充足人数分别为10和2名，术后48 h乳汁分泌充足人数分别为18和8名，差异有统计学意义（P值分别为0.021和0.008）。术后2 h按摩组术后6、12、24、48和72 h血清泌乳素含量分别为（195.9±78.5）、（176.0±96.5）、（216.4±110.0）、（190.0±56.8）和（184.8±69.6）μg/L，高于对照组[分别为（128.8±40.6）、（127.3±66.8）、（162.2±58.8）、（145.1±64.7）和（141.7±49.3）μg/L]（P=0.007）。结论 剖宫产术后2 h进行乳房按摩可有效改善剖宫产产妇泌乳状况。

Objective To evaluate the effect of breast massage at different time in the early period on maternal lactation after cesarean section.Methods 80 women delivered by cesarean section were randomly selected from maternity ward of a hospital in Shandong province during Jan. 2013 to Jan. 2015; which were divided into four groups, with 20 patients in each. Three groups received 3 times of breast massage every 24 hoursbeginning from 2, 12 and 24 h after cesarean section, respectively. The control group didn＇t receive any breast massage. The starting time and status of lactation were observed and recorded after cesarean section. 5 ml venous blood sample was drawn from each patient respectively at 2 h before cesarean, 6, 12, 24, 48 and 72 h after cesarean to test the level of serum prolactin. The lactation status of each group was compared.Results The P50 （P25-P75） of starting time of lactation of the three massage groups and control group were 3 （2-6） h, 4 （2-8） h, 4 （3-12） h and 4 （2-12） h, respectively, whose differences showed no statistical significance （H=3.32, P=0.345）.The number of delivered women with adequate lactation 24 hours after cesarean was 10 in the group who received massage beginning from 2 h after cesarean; while the number was only 2 in the control group. The number of delivered women with adequate lactation 48 hours after cesarean was 18 in the group who received massage beginning from 2 h after cesarean; while the number was 8 in the control group. The differences showed statistical significances （P values were 0.021 and 0.008, respectively）. The serum prolactin level in the group of delivered women who received massage from 2 h after cesarean was separately （195.9±78.5）, （176.0±96.5）, （216.4±110.0）, （190.0±56.8） and （184.8±69.6） μg/L at 2, 12, 24, 48 and 72 h after cesarean, which were significantly higher than those in the control group （which were （128.8±40.6）, （127.3±66.8）, （162.2±58.8）, （145.1±64.7） and （141.7±49.3） μg/L, respectively） （P=0.007）.Conclusion Breast massage beginning from 2 hours after cesarean section can effectively improve the lactation status of delivered women.