无痛分娩不同麻醉方案对产妇泌乳功能、肠道功能及应激反应的影响

Effects of different anesthesia protocols for painless labor of parturients on their lactation function,intestinal function,and stress response

目的:分析腰硬联合麻醉和硬膜外麻醉用于无痛分娩对产妇泌乳功能、肠道功能及应激反应的影响。方法:选取2020年1月-2021年1月在本院阴道分娩的180例单胎产妇为研究对象,行腰硬联合麻醉60例为联合组,行硬膜外麻醉60例为硬膜组,常规分娩60例为常规组。比较各组分娩过程疼痛程度,产后泌乳、肠道功能及分娩前、后应激反应情况。结果:联合组、硬膜组第一产程时间、第二产程时间和宫口全开时间均低于常规组(P<0.05);3组第三产程时间、新生儿5min Apgar评分均无差异(P>0.05)。联合组和硬膜组第二产程、第三产程和宫口全开时VAS评分均低于常规组(P<0.05);3组第一产程VAS评分,以及联合组和硬膜组第二产程、第三产程和宫口全开时VAS评分均无差异(P>0.05);联合组麻醉起效时间较硬膜组缩短,麻醉持续时间较硬膜组延长,两组产后初乳时间和肠道蠕动恢复时间均低于常规组,产后24h泌乳量评分高于常规组,联合组产后初乳时间和肠道蠕动恢复时间均低于硬膜组,产后24h泌乳量评分高于硬膜组(均P<0.05)。3组产后血清皮质醇(Cor)、去甲肾上腺素(NE)、NO水平均较产前升高,且联合组、硬膜组、常规组依次升高(均P<0.05)。结论:无痛分娩有较好的麻醉镇痛和缩短产程之效,与硬膜外麻醉相比,腰硬联合麻醉在麻醉起效时间、麻醉持续时间方面更具优势,且可有效改善产后泌乳、肠道功能恢复,缓解产妇应激反应。

Objective:To analyze the effects of combined spinal-epidural anesthesia and epidural anesthesia for painless labor of parturients on their lactation function,intestinal function,and stress response.Methods:A total of 180 singleton parturients who had been vaginal delivery in hospital were selected as the research objects from January 2020 to January 2021.60 parturients who underwent combined spinal-epidural anesthesia were included in group A,and 60 parturients who had undergone epidural anesthesia were included in group B,and 60 parturients who had undergone routine delivery were included in group C.The pain degree during delivery,the postpartum lactation,the intestinal function,and the stress reaction of the parturients were compared among the three groups.Results:The first stage of labor time,the second stage of labor time,and the time to full opening of the uterus orifice of the parturients in group A and group B were significantly lower than those of the parturients in group C(P<0.05).There were no significant differences in the time of the third stage of labor and 5min Apgar score of the newborns of the parturients among the three groups(P>0.05).The VAS scores of the parturients during the second and the third stages of labor and at the time of full opening of the uterus orifice in group A and group B were significantly lower than those of the parturients in group C(P>0.05).There were no significant differences in the VAS scores of the parturients during the first stage of labor among the three groups.There were no significant differences in the VAS scores of the parturients during the second stage of labor,the third stage of labor,and the time to full opening of the uterus orifice of the parturients between group A and group B(P>0.05).The onset time of anesthesia of the parturients in group A was significantly shorter than that of the parturients in group B,and the duration of anesthesia of the parturients in group A was significantly longer than that of the parturients in group B.The postpartum colostrum feeding time and the intestinal peristalsis recovery time of the parturients in group A and group B were significantly lower than those of the parturients in group C.The score of lactation volume of the parturients at postpartum 24hin group A and group B was significantly higher than those of the parturients in group C.The postpartum colostrum feeding time and the intestinal peristalsis recovery time of the parturients in group A were significantly lower than those of the parturients in group B.The score of lactation volume of the parturients in group A at postpartum 24hwas significantly higher than those of the parturients in group B(all P<0.05).The levels of serum cortisol(Cor),norepinephrine(NE),and NO of the parturients in the three groups after delivery had increased significantly.And which of the parturients in group A,group B and group C had increased gradually(all P<0.05).Conclusion:Painless delivery has better anesthesia and analgesia effect for the parturients,and which can shorten the stage of labor.Comparing that of epidural anesthesia,combined lumbar and epidural anesthesia for the parturients has more advantages,such as on the onset time and duration of anesthesia,and which can effectively improve postpartum lactation,intestinal function recovery,and relieve maternal stress response.