硬膜外阻滞分娩镇痛对产妇泌乳素水平的影响
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摘要
目的探讨硬膜外阻滞分娩镇痛对产妇泌乳素(PRL)水平的影响。方法选择2016年10月至2017年5月在新乡医学院第一附属医院进行分娩的60例初产妇为研究对象,将产妇分为观察组与对照组,每组30例。观察组产妇给予盐酸罗哌卡因复合枸橼酸舒芬太尼硬膜外阻滞分娩镇痛;对照组产妇不采取任何措施行自然分娩。比较2组产妇的疼痛评分、产程、泌乳量,镇痛前及产后24、48 h血清泌乳素(PRL)水平,产后30 min和24、48 h始动泌乳情况。结果观察组产妇第1产程活跃期明显短于对照组(P<0.05);观察组与对照组产妇第1产程潜伏期、第2产程、第3产程比较差异均无统计学意义(P>0.05)。2组产妇镇痛前疼痛评分比较差异无统计学意义(P>0.05);观察组产妇于宫口开3 cm、宫口开全及胎儿娩出时疼痛评分均低于对照组(P<0.05)。2组产妇镇痛前血清PRL水平比较差异无统计学意义(P>0.05);观察组产妇产后24、48 h的血清PRL水平显著高于对照组(P<0.05)。观察组产妇产后始动泌乳情况优于对照组(P<0.05)。观察组产妇产后24、48 h的泌乳量显著多于对照组(P<0.05)。结论硬膜外阻滞分娩镇痛能够减轻产妇疼痛,缩短第1产程的活跃期,增加产妇泌乳素水平,增加产后泌乳量。
Objective To explore the effect of epidural labor analgesia on the prolactin( PRL) levels of parturient.Methods Sixty primipara who delivered in the First Affiliated Hospital of Xinxiang Medical University from October 2016 to May 2017 were selected as research object. The parturient were divided into observation group and control group,with 30 cases in each group. The parturient in observation group were given ropivacaine combined with sufentanil for epidural block labor analgesia; the parturient in control group took natural production method without any analgesia method. The pain score,duration of labor,milk yield,serum PRL level before analgesia and 24,48 h postpartum and the number of initial lactation at 30 min,24 h,48 h postpartum of maternal were compared between the two groups. Results The active period of the first stage of labor of parturient in the observation group was significantly shorter than that in the control group( P < 0. 05); there was no statistic difference in the latent period of the first stage of labor,the second stage of labor and the third stage of labor of parturient between the observation group and the control group( P > 0. 05). There was no statistic difference in the pain score of parturient between the two groups before analgesia( P > 0. 05); the pain score of parturient in observation group was significantly lower than that in the control group at the time point of uterine orifice open 3 cm,uterine orifice full dilatation and fetal disengagement( P < 0. 05). There was no statistic difference in the PRL levels of parturient between the two groups before analgesia( P > 0. 05); the PRL level of parturient in observation group was significantly higher than that in the control group at 24,48 h postpartum( P < 0. 05). The condition of initial lactation of maternal in the observation group was significantly better than that in the control group( P < 0. 05). The milk yield of parturient in observation group was significantly more than that in the control group at 24,48 h postpartum( P < 0. 05). Conclusion Epidural analgesia can reduce the pain of parturient,shorten the active stage of the first stage of labor,increase the level of PRL and increase the milk yield of the postpartum.
Objective To explore the effect of epidural labor analgesia on the prolactin( PRL) levels of parturient.Methods Sixty primipara who delivered in the First Affiliated Hospital of Xinxiang Medical University from October 2016 to May 2017 were selected as research object. The parturient were divided into observation group and control group,with 30 cases in each group. The parturient in observation group were given ropivacaine combined with sufentanil for epidural block labor analgesia; the parturient in control group took natural production method without any analgesia method. The pain score,duration of labor,milk yield,serum PRL level before analgesia and 24,48 h postpartum and the number of initial lactation at 30 min,24 h,48 h postpartum of maternal were compared between the two groups. Results The active period of the first stage of labor of parturient in the observation group was significantly shorter than that in the control group( P < 0. 05); there was no statistic difference in the latent period of the first stage of labor,the second stage of labor and the third stage of labor of parturient between the observation group and the control group( P > 0. 05). There was no statistic difference in the pain score of parturient between the two groups before analgesia( P > 0. 05); the pain score of parturient in observation group was significantly lower than that in the control group at the time point of uterine orifice open 3 cm,uterine orifice full dilatation and fetal disengagement( P < 0. 05). There was no statistic difference in the PRL levels of parturient between the two groups before analgesia( P > 0. 05); the PRL level of parturient in observation group was significantly higher than that in the control group at 24,48 h postpartum( P < 0. 05). The condition of initial lactation of maternal in the observation group was significantly better than that in the control group( P < 0. 05). The milk yield of parturient in observation group was significantly more than that in the control group at 24,48 h postpartum( P < 0. 05). Conclusion Epidural analgesia can reduce the pain of parturient,shorten the active stage of the first stage of labor,increase the level of PRL and increase the milk yield of the postpartum.
引文
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[9]徐文平,刘林,肖飞,等.罗哌卡因联合舒芬太尼硬膜外麻醉对可行走无痛分娩阵镇痛的效果研究[J].中国生化药物杂志,2017,37(4):320-322.
[10]杨梅,朱雁鸿,胡燕,等.罗哌卡因联合芬太尼连续硬膜外阻滞用于无痛分娩临床研究[J].昆明医科大学学报,2014,35(12):148-151.
[2]黄东林,修玉芳,肖龙.椎管内麻醉用于分娩镇痛对产妇血清泌乳素的影响[J].临床麻醉学杂志,2009,25(5):450-451.
[3]刘玉秋,王野,王梓.潜伏期分娩镇痛对产妇泌乳的影响[J].齐鲁医学杂志,2011,26(3):225-226.
[4]程丽丽.剖宫产及硬膜外分娩镇痛对产后泌乳的影响及机制探讨[J].中国医药指南,2011,9(12):86-87.
[5]周鸿亚.在无痛分娩中对产妇及新生儿情况的分析[J].中国医药指南,2015,13(10):154-155.
[6]SMITH C A,LEVETT K M,COLLINS C T,et al.Massage,reflexology and other manual methods for pain management in labour[J].Cochrane Database Syst Rev,2012,2(2):CD009290.
[7]张宠英.自然分娩产妇产程与心理、生理及社会支持的相关性研究[J].中国妇幼保健,2012,27(15):2277-2279.
[8]毛玉芬,王美云.腰麻-硬膜外联合阻滞麻醉用于分娩镇痛的临床观察[J].临床和实验医学杂志,2011,10(18):1464-1465.
[9]徐文平,刘林,肖飞,等.罗哌卡因联合舒芬太尼硬膜外麻醉对可行走无痛分娩阵镇痛的效果研究[J].中国生化药物杂志,2017,37(4):320-322.
[10]杨梅,朱雁鸿,胡燕,等.罗哌卡因联合芬太尼连续硬膜外阻滞用于无痛分娩临床研究[J].昆明医科大学学报,2014,35(12):148-151.