罗比卡因用于剖宫产术后硬膜外镇痛对血浆泌乳素的影响

Effects of postoperative epidural analgesia with ropivacaine after cesarean section on plasma concentration of prolactin

目的 探讨剖宫产术后病人硬膜外连续注射 0 2 %罗比卡因对泌乳素的影响。方法 6 0例健康足月产妇 ,择期在联合椎管内麻醉下施行剖宫产术。术毕随机等分为镇痛组和对照组 :镇痛组行硬膜外镇痛 ,注入 0 2 %罗比卡因 (5ml/h)持续 4 8h镇痛 ;对照组术毕拔出硬膜外导管。采用放射免疫法测定血浆泌乳素 (PRL) ,视觉模拟评分 (VAS)估计镇痛效果。结果 镇痛组VAS明显低于对照组 (P <0 0 1) ,两组术后PRL均较术前明显升高 (P <0 0 1) ,镇痛组PRL高于对照组 ,2 4h具有显著性差异 (P <0 0 5 ) ,4 8h具有非常显著性差异 (P <0 0 1) ;镇痛组初乳时间较对照组提前 (P<0 0 5 ) ,婴儿体重增加明显高于对照组 (P <0 0 5 ) ,镇痛组肠蠕动恢复时间明显快于对照组 (P <0 0 5 )术后生命体征平稳 ,无恶心呕吐、头痛、肢体麻木发生。结论 剖宫产术后罗比卡因硬膜外镇痛效果确切安全 ,能促进PRL分泌 ,初乳时间提早 ,增加婴儿体重。

Objective To determine the effects of postoperative epidural analgesia with ropivacaine after cesarean section on the plasma concentration of prolactin Methods Sixty parturients at term undergoing selective cesarean section under combined spinal epidural anesthesia were equally and randomly allocated to receive postoperative epidural ropivacaine ( n= 30, analgesia group) and controlgroup( n= 30) Epidural analgesia was performed for 48 hrs with a continuous epidural infusion (5ml/h) of 0 2% ropivacaine The plasma prolactin level was determined with radioimmunoassay The analgesic efficacy was evaluated with visual analog scale(VAS) Results The VAS score was significantly lower in analgesia group than that in control group( P< 0 01) In both groups, prolactin levels were significantly increased after operations ( P< 0 01) The increase rate was greater, however, in the analgesia group( P< 0 05) Lactation started earlier in analgesia group than that in control group ( P< 0 05) The infant weight gain was more marked in the analgesia group( P< 0 05) The duration by which the intestine resumed its motor function was greatly shortened in analgesia group( P< 0 01) Heart rate and blood pressure were stable during whole procedures, without nausea, vomiting, headache and numbness of the limbs Conclusion Continuous epidural ropivacaine after cesarean section produced a satisfactory postoperative pain relief An increase prolactin of secretion, improvement of maternal colostrum and a marked gain of infant body weight were observed