Objective To analyze the effects of anesthesia induction and maintenance by remifentanil tar-get-controlled infusion on lactation and breast-feeding in pregnant women with cesarean section under general anesthe-sia.Methods A total of of 120 pregnant women who underwent cesarean section in Xiangyang Maternal and Child Care Hospital from April 2016 to April 2017 were selected and divided into the observation group(n=60)and the control group (n=60)according to the different ways of anesthetic administration.The observation group received target-controlled infu-sion of remifentanil for anesthesia induction and maintenance,and the control group was treated with intravenous infusion of remifentanil for anesthesia induction at constant speed to maintain anesthesia.Fetuses of the two groups were given the same anesthesia after delivery.The mean arterial pressure(MAP),heart rate(HR)and neonatal status were closely moni-tored in the two groups before maternal anesthesia(T0),at tracheal intubation(T1),immediately after skin incision(T2) and at extubation after operation(T3).The maternal lactation starting time,the amount of milk within 48 hours after opera-tion,and postpartum breastfeeding within 6 weeks were recorded between the two groups.Results There was no signifi-cant difference in MAP and HR between the two groups of parturients at T0(P>0.05).The variation of MAP and HR in the observation group at T1 and T2 were less significant than those in the control group(P<0.05).The delivery time of observa-tion group was significantly shorter than that of the control group,(6.42±2.94)min vs(7.68±3.20)min,P<0.05).The Apgar scores at 5 min and 10 min after delivery were(9.04±1.05),(9.50±0.49)in the observation group versus(8.62±1.13),(9.08± 0.62)in the control group(P<0.05).The rate of lactation starting time<24 h,the proportion of puerperas with large amount of milk within 48 h after operation,and the postpartum breastfeeding rate within 6 weeks were 73.33%,51.67%,78.33% in the observation group versus 51.67%,33.33%,58.33% in control group(P<0.05).Conclusion Compared with intravenous infu-sion at constant speed,anesthesia induction and maintenance by remifentanil target-controlled infusion has smaller effect on hemodynamics of maternal women with cesarean section and smaller impact on the fetus,which can help to improve the ma-ternal lactation starting time,promote lactation,and improve the success rate of breastfeeding.%目的 分析瑞芬太尼靶控输注诱导及维持麻醉对全麻下剖宫产孕妇乳汁分泌及母乳喂养的影响.方法 回顾性选取2016年4月至2017年4月期间在襄阳市妇幼保健院产检并接受剖宫产分娩的120例产妇的临床资料,根据不同的麻醉给药方式将产妇分为观察组(瑞芬太尼靶控输注诱导及维持麻醉,n=60)和对照组(瑞芬太尼静脉注射诱导和恒速输注维持麻醉,n=60),两组胎儿娩出后麻醉处理相同,密切监测两组产妇麻醉前(T0)、气管插管即刻(T1)、切皮后即刻(T2)、术后拔管时(T3)平均动脉压(MAP)、心率(HR)及新生儿情况,记录产妇泌乳始动时间、术后48 h内乳汁量、产后6周内母乳喂养情况.结果 两组产妇的T0时MAP、HR比较差异均无统计学意义(P>0.05),T1、T2时观察组产妇的MAP、HR变化幅度均明显低于对照组,差异均有统计学意义(P<0.05);观察组胎儿娩出时间为(6.42±2.94)min,明显短于对照组的(7.68±3.20)min,且娩出后5 min、10 min Apgar评分分别为(9.04±1.05)分、(9.50±0.49)分,明显高于对照组的(8.62±1.13)分、(9.08±0.62)分,差异均有统计学意义(P<0.05);观察组产妇泌乳始动时间<24 h者占73.33%,产后48 h内乳汁量多者占51.67%,产后6周内母乳喂养率为78.33%,均明显高于对照组的51.67%、33.33%、58.33%,差异均有统计学意义(P均<0.05).结论 相比于静脉注射、恒速输注的给药方式,瑞芬太尼靶控输注诱导及维持麻醉对剖宫产产妇血流动力学及胎儿的影响更小,其有助于改善产妇泌乳始动时间,增加泌乳量及提高母乳喂养成功率.
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