潜伏期分娩镇痛对产妇泌乳的影响

目的研究潜伏期分娩镇痛的效果及对产妇泌乳的影响。方法 90例无产科并发症及硬膜外穿刺禁忌证的单胎足月初产妇,随机分为3组。潜伏期镇痛组当进入产程、宫颈口〈3 cm时进行硬膜外镇痛;活跃期镇痛组当宫颈口≥3 cm时进行硬膜外镇痛;对照组不用任何镇痛措施。结果各组间产程时间、中转剖宫产率、器械助产率、产后出血量及新生儿Apgar评分比较差异无显著性（P〉0.05）;潜伏期镇痛组第一产程潜伏期VAS评分与活跃期镇痛组及对照组比较差异有显著性（F=78.6,q=9.89、15.63,P〈0.01）;潜伏期镇痛组及活跃期镇痛组第一产程活跃期与第二产程VAS评分与对照组比较差异有显著性（F=80.2、126.3,q=12.36～18.32,P〈0.01）。各组产妇血清泌乳素水平均较产前明显增高（t=2.47～5.07,P〈0.01）,潜伏期镇痛组产妇产后24 h的血清泌乳素水平高于活跃期镇痛组及对照组（t=2.48、4.51,P〈0.01）;潜伏期镇痛组产妇产后泌乳始动时间短,与活跃期镇痛组及对照组比较差异有显著性（t=3.46、3.84,P〈0.01）。结论罗哌卡因复合舒芬太尼潜伏期硬膜外分娩镇痛安全有效,可促进泌乳素分泌,有利于母乳喂养。

THE EFFECT OF LATENCY CHILDBIRTH ANALGESIA ON LACTATING OF LYING-IN WOMEN

Objective To study the effect of latency childbirth analgesia on lactating of lying-in women. MethodsNinety full-term single birth primiparous women with no obstetrical complications and epidural puncture contraindications were randomized to three groups： latency analgesia（LA） group,an epidural analgesia was performed while getting into birth process,and cervical dilatation 3 cm;active-phase analgesia（APA） group： epidural analgesia given at cervix dilation ≥3 cm）;control group： no analgesia given. Results There were no significant differences among the three groups in terms of labor process,the conversion rate to caesarean section or instrumental delivery,postpartum bleeding and newborn＇s Apgar score（P0.05）.VAS score of latency phase in LA group showed significant difference as compared with APA and the control group（F=78.6;q=9.89,15.63;P0.01）.The differences of VAS scores of LA group and APA group in the first and second birth process were significant compared with that in the control group（F=80.2,126.3;q=12.36-18.32;P0.01）.Serum prolactin increased in all three groups after childbirth（t=2.47,5.07;P0.01）.The level of serum prolactin in those 24 h after childbirth in LA group was higher than that in the APA and control groups（t=2.48,4.51;P0.01）.The initiating time of postpartum lactation in LA group was earlier than that in the control and APA group（t=3.46,3.84;P0.01）. Conclusion Epidural analgesia with ropivacaine plus sufentanil for latency childbirth can promote the secretion of prolactin,in favour of breast feeding.