中华妇产科杂志
中華婦產科雜誌
중화부산과잡지
CHINESE JOUNAL OF OBSTETRICS AND GYNECOLOGY
2008年
7期
502-505
,共4页
陈咏玫%LI Zhi%王爱军%WANG Jia-mei
陳詠玫%LI Zhi%王愛軍%WANG Jia-mei
진영매%LI Zhi%왕애군%WANG Jia-mei
镇痛,产科%酰胺类%催乳素%泌乳
鎮痛,產科%酰胺類%催乳素%泌乳
진통,산과%선알류%최유소%비유
Analgesia,obstetrical%Amides%Prolactin%Lactation
目的 探讨罗哌卡因用于足月产妇阴道分娩镇痛对催乳素(PRL)水平、泌乳始动时间及泌乳量充足率的影响.方法 选择北京市海淀区妇幼保健院产科2006年1月至2007年6月足月阴道分娩产妇124例,随机分为分娩镇痛组75例,对照组49例.分娩镇痛组产妇应用硬膜外电子镇痛泵持续泵入罗哌卡因用于分娩镇痛,先以0.125%罗哌卡因3 ml注入硬膜外腔,观察5 min无异常反应后再注入12 ml,将麻醉平面控制在胸10以下,以5 ml/h(0.104 mg/min)的速度持续泵入罗哌卡因,直至宫口开全后关闭镇痛泵.对照组为自然分娩产妇,不用任何镇痛措施.应用微粒子化学发光法分别测定两组产妇产前、产后0、2、6、12和24 h血清催乳素水平,记录泌乳始动时间和每日新生儿哺乳次数,并以新生儿排尿次数和哺乳后睡眠时间判断泌乳量充足与否,测量产后24 h的新生儿体重下降情况.结果 (1)两组产妇催乳素水平产后即开始升高,于产后2 h达到高峰,并于产后24 h维持在较高水平上.(2)分娩镇痛组产妇催乳素水平在产后2、24 h分别为(19.5±8.4)、(14.5±5.6)nmol/L,对照组产妇催乳素水平在产后2、24 h分别为(22.6±7.2)、(16.9±5.7)nmol/L,两组分别比较,差异均有统计学意义(P<0.05).(3)分娩镇痛组产妇泌乳始动时间在产后24 h内者为73例(97%,73/75),泌乳量充足率在产后48 h内为73%(55/75),产后24 h新生儿体重下降(57±42)g;对照组产妇泌乳始动时间在产后24 h内为45例(92%,45/49),泌乳量充足率在产后48 h为57%(28/49),产后24 h新生儿体重下降(62±40)g,两组分别比较,差异均无统计学意义(P>0.05).结论 (1)罗哌卡因用于分娩镇痛可影响产妇的催乳素分泌,但不影响泌乳始动时间和泌乳量充足率.(2)罗哌卡因用于分娩镇痛时,产妇催乳素仍处于较高水平,以满足泌乳的必要条件.
目的 探討囉哌卡因用于足月產婦陰道分娩鎮痛對催乳素(PRL)水平、泌乳始動時間及泌乳量充足率的影響.方法 選擇北京市海澱區婦幼保健院產科2006年1月至2007年6月足月陰道分娩產婦124例,隨機分為分娩鎮痛組75例,對照組49例.分娩鎮痛組產婦應用硬膜外電子鎮痛泵持續泵入囉哌卡因用于分娩鎮痛,先以0.125%囉哌卡因3 ml註入硬膜外腔,觀察5 min無異常反應後再註入12 ml,將痳醉平麵控製在胸10以下,以5 ml/h(0.104 mg/min)的速度持續泵入囉哌卡因,直至宮口開全後關閉鎮痛泵.對照組為自然分娩產婦,不用任何鎮痛措施.應用微粒子化學髮光法分彆測定兩組產婦產前、產後0、2、6、12和24 h血清催乳素水平,記錄泌乳始動時間和每日新生兒哺乳次數,併以新生兒排尿次數和哺乳後睡眠時間判斷泌乳量充足與否,測量產後24 h的新生兒體重下降情況.結果 (1)兩組產婦催乳素水平產後即開始升高,于產後2 h達到高峰,併于產後24 h維持在較高水平上.(2)分娩鎮痛組產婦催乳素水平在產後2、24 h分彆為(19.5±8.4)、(14.5±5.6)nmol/L,對照組產婦催乳素水平在產後2、24 h分彆為(22.6±7.2)、(16.9±5.7)nmol/L,兩組分彆比較,差異均有統計學意義(P<0.05).(3)分娩鎮痛組產婦泌乳始動時間在產後24 h內者為73例(97%,73/75),泌乳量充足率在產後48 h內為73%(55/75),產後24 h新生兒體重下降(57±42)g;對照組產婦泌乳始動時間在產後24 h內為45例(92%,45/49),泌乳量充足率在產後48 h為57%(28/49),產後24 h新生兒體重下降(62±40)g,兩組分彆比較,差異均無統計學意義(P>0.05).結論 (1)囉哌卡因用于分娩鎮痛可影響產婦的催乳素分泌,但不影響泌乳始動時間和泌乳量充足率.(2)囉哌卡因用于分娩鎮痛時,產婦催乳素仍處于較高水平,以滿足泌乳的必要條件.
목적 탐토라고잡인용우족월산부음도분면진통대최유소(PRL)수평、비유시동시간급비유량충족솔적영향.방법 선택북경시해정구부유보건원산과2006년1월지2007년6월족월음도분면산부124례,수궤분위분면진통조75례,대조조49례.분면진통조산부응용경막외전자진통빙지속빙입라고잡인용우분면진통,선이0.125%라고잡인3 ml주입경막외강,관찰5 min무이상반응후재주입12 ml,장마취평면공제재흉10이하,이5 ml/h(0.104 mg/min)적속도지속빙입라고잡인,직지궁구개전후관폐진통빙.대조조위자연분면산부,불용임하진통조시.응용미입자화학발광법분별측정량조산부산전、산후0、2、6、12화24 h혈청최유소수평,기록비유시동시간화매일신생인포유차수,병이신생인배뇨차수화포유후수면시간판단비유량충족여부,측양산후24 h적신생인체중하강정황.결과 (1)량조산부최유소수평산후즉개시승고,우산후2 h체도고봉,병우산후24 h유지재교고수평상.(2)분면진통조산부최유소수평재산후2、24 h분별위(19.5±8.4)、(14.5±5.6)nmol/L,대조조산부최유소수평재산후2、24 h분별위(22.6±7.2)、(16.9±5.7)nmol/L,량조분별비교,차이균유통계학의의(P<0.05).(3)분면진통조산부비유시동시간재산후24 h내자위73례(97%,73/75),비유량충족솔재산후48 h내위73%(55/75),산후24 h신생인체중하강(57±42)g;대조조산부비유시동시간재산후24 h내위45례(92%,45/49),비유량충족솔재산후48 h위57%(28/49),산후24 h신생인체중하강(62±40)g,량조분별비교,차이균무통계학의의(P>0.05).결론 (1)라고잡인용우분면진통가영향산부적최유소분비,단불영향비유시동시간화비유량충족솔.(2)라고잡인용우분면진통시,산부최유소잉처우교고수평,이만족비유적필요조건.
Objective To examine the effect of labor analgesia with ropivacaine on maternal serum prolactin, time of first eolostrum production and the rate of abundant lactation. Methods A total of 124 women of vaginal delivery were randomly divided into labor analgesia group (n = 75 ) and control group (n =49). Labor analgesia group received ropivacaine by patient-controlled epidural analgesia. Three ml ropivacaine (0.125% ) was injected through an epidural catheter and another 12 ml ropivacaine was injected 5 min later if there were no total spinal anesthesia. The block level of analgesia was controlled to be below T10 level. Then 5 ml (0.104 mg/min) ropivacaine per hour was continuously pumped till full dilation of ostium of the uterus. The control group consisted of women of normal spontaneous delivery with no pain relieving measure. The prolactin levels of antepartum, postpartum 0 h, 2 h, 6 h, 12 h and 24 h were determined by microparticle chemoluminescence. Starting time of lactation, the feeding times in 24 hours,the rate of abundant lactation, and neonatal weight 24 hours after delivery were recorded. Results ( 1 ) The serum prolactin of both groups increased instantly after delivery, reached a peak 2 hours after delivery and kept high levels 24 hours after delivery. (2)The prolactin levels of labor analgesia group [(19. 5±8.4)nmol/L and ( 14. 5 ± 5.6 ) nmol/L] were lower than those of control group [( 22.6±7. 2 ) nmol/L and ( 16. 9 ± 5.7 ) nmol/L] 2 and 24 hours after delivery ( P < 0. 05 ). ( 3 ) In labor analgesia group the starting time of lactation was within 24 hours after delivery in 73 cases (97%), lactation amount was abundant within 48 hours in 55 cases (73%) and newborn weight reduction in the first day after delivery was(57 ±42)g. In control group the starting time of lactation was within 24 hours after delivery in 45 cases (92%),lactation amount was abundant within 48 hours in 28 cases (57%) and newborn weight reduction in the first day after delivery was( 62±40)g. There were no differences between the two groups in the starting time of lactation, the rate of abundant lactation, and newborn weight reduction ( P > 0. 05 ). Conclusions ( 1 )Epidural anesthesia with ropivacaine might affect the secretion of prolactin, while the starting time and amount of lactation may be affected by other factors. (2) Prolactin increases after delivery, reaches a peak 2 hours after delivery and maintains high levels 2.4 hours after delivery, which contented necessary for lactation.
