瑞芬太尼PCIA联合水针穴位注射对产妇泌乳及新生儿觅食吸吮反射的影响

Effect of combination of remifentanil PCIA and water acupuncture on puerperae’s lactation function of and newborns’ foraging and sucking reflex

目的探讨瑞芬太尼PCIA联合水针穴位注射对产妇泌乳功能及新生儿觅食吸吮反射的影响。方法 选择本院2018年1—12月初产妇100例,随机分为两组,每组50例。实验组采用瑞芬太尼PCIA联合水针穴位注射分娩镇痛,对照组无分娩镇痛。观察泌乳始动时间,产后24、48h泌乳量;分别测定镇痛前,镇痛后1h和分娩后1h两组初产妇视觉模拟评分(VAS)、血浆去甲肾上腺素(NE)和肾上腺素(E)含量及镇痛前、产后24h、48h血清催乳素PRL水平,测定新生儿觅食吸吮反射评分。结果 实验组泌乳始动时间明显短于对照组([25.1±9.1)h比(34.7±9.8)h],两组比较差异有统计学意义(P<0.05);产后24、48h实验组泌乳量充足的初产妇明显多于对照组(P<0.05);镇痛后1h实验组VAS评分明显低于对照组[(2.2±1.5)分比(8.5±1.6)分,P<0.05];镇痛后1h和分娩后1h实验组血浆NE和E含量低于对照组(P<0.05);产后24、48h实验组PRL均高于对照组(P<0.05)。两组新生儿产后5min觅食吸吮反射比较差异无统计学意义(P>0.05)。结论 瑞芬太尼PCIA联合水针穴位注射可有效调控产妇应激反应,增加PRL分泌,促进早泌乳,增加泌乳量;对新生儿觅食吸吮反射无影响。

Objective To study the effect of the combination of remifentanil PCIA and water acupuncture on puerperae’s lactation function and newborns’ foraging and sucking reflex. Methods 100 primiparae were randomly divided into an experimental group and a control group, 50 cases for each group. The experimental group were treated with remifentanil PCIA and water acupuncture, while the control group took no treatment. The starting time of lactation and milk quantities 24 and 48 h after delivery were observed. The VAS scores, the plasma concentrations of norepinephrine (NE) and epinephrine (E) before and 1 h after analgesia and after delivery were measured. The serum prolactin levels before the analgesia and 24 and 48 h after delivery and the neonatal feeding and sucking reflex scores were measured. Results The starting time of lactation [(25.1±9.1) h vs.(34.7±9.8) h] was significantly shorter, more primiparae were sufficient in milk quantity 24 and 48 h after delivery, the VAS score 1 h after analgesia [(2.2±1.5) vs.(8.5±1.6)] and the concentrations of NE and E 1 h after analgesia and 1 h after deliver was lower, and the PRL 24 and 48 h after delivery were higher in experimental group than in the control group, with statistical differences (all P < 0.05). The was no statistical difference in the newborns’ foraging and sucking reflex of the newborn between the two groups.Conclusion The combination of remifentanil PCIA and water acupuncture can effectively control the maternal stress reaction, increase the secretion of PRL and promote early lactation and lactation amount, and has no obvious influence on newborns’ foraging and sucking reflex.