持续硬膜外镇痛与自控硬膜外镇痛对产妇应激反应、泌乳功能及新生儿阿氏评分的影响对比

Comparative study of effects of continuous epidural analgesia and self-controlled epidural analgesia on maternal stress response,lactation function and neonatal Apgar score

目的:对比持续硬膜外镇痛与自控硬膜外镇痛对产妇应激反应、泌乳功能及新生儿阿氏评分的影响。方法:选择2017年2月至2019年5月我院收治的98例产妇进行研究,随机分为对照组和观察组(n=49)。对照组患者以罗哌卡因与舒芬太尼持续硬膜外镇痛进行无痛分娩,观察组以相同药物行自控硬膜外镇痛。采用放射免疫法测定两组产妇分娩前、后血清促肾上腺皮质激素(Adrenocor ticotropic hormore,ACTH)、皮质醇(Cortisol,COR)、去甲肾上腺素(Norepinephrine,NE)及肾上腺素(Epinephrine,E);分娩前、分娩后30 min、24 h、48 h以酶联免疫吸附法检测泌乳素的变化;同时进行新生儿阿氏评分。结果:分娩后两组产妇ATCH、COR、NE及E均明显下降(P<0.05),且分娩后泌乳素水平均随时间的增加而增加(P<0.05),以观察组效果更为显著(P<0.05)。两组新生儿分娩后1 min、分娩后5 min阿氏评分对比差异均无统计学意义(P>0.05)。结论:自控硬膜外镇痛无痛分娩与持续硬膜外镇痛新生儿阿氏评分均较高,具有较高的安全性。自控硬膜外镇痛无痛分娩可明显缓解产妇应激反应,改善泌乳功能。

Objective:To compare the effects of continuous epidural analgesia and self-controlled epidural analgesia on stress response,lactation function and neonatal Apgar score.Methods:A total of 98 maternal patients admitted to our hospital from February 2017 to May 2019 were selected and randomly divided into control group and observation group(n=49).The patients in the control group received continuous epidural analgesia with ropivacaine and sufentanil for painless delivery,and the patients in the observation group received self-control epidural analgesia with the same drug.The serum levels of adrenocorticotropic hormone(ACTH),cortisol(COR),norepinephrine(NE)and epinephrine(E)were measured by radioimmunoassay;and the changes of prolactin were detected by enzyme-linked immunosorbent assay before delivery,30 minutes,24 hours and 48 hours after delivery.Also the neonatal Apgar scores were evaluated.Results:Compared with pre-delivery,ATCH,COR,NE and E of all patients were decreased significantly(P<0.05),and the level of prolactin was increased with time(P<0.05),especially in the observation group(P<0.05).There was no significant difference in the neonatal Apgar between the two groups at 1 min and 5 min after delivery(P>0.05).Conclusion:Both the self-control epidural analgesia and the continuous epidural analgesia had a higher Apgar score and a higher safety.Moreover,self-control epidural analgesia could significantly alleviate the stress response of the parturient and improve the lactation function.