布托啡诺静脉自控镇痛对产妇泌乳素影响研究.docVIP

布托啡诺静脉自控镇痛对产妇泌乳素影响研究 　　摘 要 目的：布托啡诺静脉自控镇痛对产妇泌乳素的影响。方法：将90例ASAⅠ～Ⅱ足月妊娠，无严重产科合并症，年龄25～30岁，无乳房发育缺陷及内分泌疾病的初产妇分3组：Ⅰ组经阴道自然分娩30例；Ⅱ组剖宫产术后布托啡诺10mg+昂丹司琼4mg采用负荷量+静脉自控镇痛给药模式（PCIA）30例。Ⅲ组硬膜外吗啡镇痛30例。采用放射免疫法测定血浆泌乳素（PRL）浓度。专人负责观察、询问、记录产妇初乳时间；对3组产妇的镇痛效果（VAS评分）、舒适度（BCS评分）、镇静（Ramesay评分）和出现的不良反应进行总结分析。结果：初乳时间Ⅱ组比Ⅰ、Ⅲ组提前（P＜0.05）；血浆PRL浓度术前3组间无明显差异（P＞0.05）。术后16、24、48小时Ⅱ组显著高于Ⅰ、Ⅲ组（P＜0.05），更明显高于术前（P＜0.01）。VAS评分：Ⅱ组和Ⅲ组镇痛效果良好，明显优于Ⅰ组（P＜0.01）。BCS评分：4、8小时Ⅱ、Ⅲ组明显低于Ⅰ组（P＜0.05）。病人术后Ramesay评分：Ⅰ组明显高于Ⅱ、Ⅲ组（P＜0.01）。不良反应方面：Ⅲ组明显高于Ⅰ、Ⅱ组（P＜0.01）结论：硬膜外吗啡镇痛效果确切，但术后不良反应较多，而应用布托啡诺静脉自控镇痛安全可靠，疗效确切，不良反应少，且能够增加PRL分泌，提前初乳时间，促进泌乳。 　　关键词 布托啡诺 剖宫产 泌乳素 静脉自控镇痛 　　AbstractTo observe the effect continuous epidural analgesia （CEA） with lappaconitine hydrobromide injection on piasma prolactin level after elective cesarean section.Methods:Ninety full-term primiparous women （ASAⅠ～Ⅱ） were selected and randomly divided into three groups.GroupⅠ,30 cases of vaginalis natural parturition without any postoperative analgesia.GroupⅡ,30 cases of cesarean section received CEA with lappaconitine hydrobromide injection.GroupⅢ,30 cases of cesarean section were without CEA postoperatively as control group.The plasma prolaction level was measured with radio immunossay.The analgesic effect was evaluated with visual analogue scale （VAS）.Results:Analgesia is effective in GroupⅡ,the colostrum within 24 hours was more earlier in CEA group than that of GroupⅠand Ⅲ（P＜0.05）.The plasma proplactin level after cesarean section or parturition was significantly higher in all there groups than those in antepartum,and was significantly higher in groupⅡ 24h and 48h after parturient than those of groupⅠand Ⅲ（P＜0.05 and P＜0.01,respectively）.Conclusion:CEA with lappaconitine hydrobromide is a safe and effective method for post-cesarean section analgesia,it increases the prolactin secretion and improves colostrums. 　　Key wordsCesarean section;Postoperative;Continous epidural analgesia;Plasma prolactin;Lappaconitine hydrobromide 　　 产妇尽早泌乳是保障婴儿母乳喂养的关键，而泌乳和射乳必须在泌乳素及催产素