不同镇痛方式对剖宫产术后镇痛及泌乳素的影响

摘要

目的：研究不同镇痛方式对剖宫产术后镇痛及泌乳素（ PRL）的影响。方法选择ASAⅠ～Ⅱ级、择期行剖宫产术患者90例，年龄22～32岁。随机分为3组：硬膜外罗哌卡因自控镇痛组（ PCEA组）、舒芬太尼静脉自控镇痛组（ PCIA组）和对照组（ C组）。3组患者均在腰麻联合硬膜外麻醉下行剖宫产术。手术结束后PCIA组静脉连接自控镇痛电子泵，药物使用舒芬太尼；PCEA组应用相同电子泵连接硬膜外导管，药物为0．125％罗哌卡因；对照组仅在需要时给予肌内注射哌替啶50 mg。术后不同时间点对3组患者进行视觉模拟评分（ VAS评分）评价镇痛效果，并测定术前，术后12、24、48 h血浆PRL水平。记录初乳时间、肠排气时间及术后并发症。结果3组患者术后12、24、48 h的血浆PRL水平较术前显著升高（P＜0．05或P＜0．01），PCIA组和PCEA组术后12、24、48 h的血浆PRL水平均显著高于C组（P＜0．05或P＜0．01）；PCIA组和PCEA组术后各时间点VAS评分均低于C组（P＜0．01），PCIA组和PCEA组间比较差异无统计学意义（P＞0．05）； PCEA组肠排气时间显著早于PCIA组和C组（P＜0．05），PCIA组和PCEA组初乳时间显著早于C组（P＜0．01）。结论 PCIA及PCEA均可安全用于产科术后镇痛，增加PRL的分泌，有利于早期泌乳。%Objective To investigate the effect of anesthetic methods on pain control and prolactin ( PRL) secretion after cesarean section .Methods Ninety ASA I-II women who were aged 22-32 years requiring selecteive cesarean section were randomized into three different groups according to their treatment of patient -controlled epidural analgesia with 0.125%ropivacaine (PCEA group), patient-controlled intravenous analgesia with sufentanil (PCIA group), and 50 mg morphine when demanded ( control group ) .Then all the patients received cesarean section under combined spinal epidural anesthesia.The visual analogue scores (VASs) were recorded to assess pain control.The levels of PRL were measured before and 12, 24, and 48 hours after operation.The time of first lactation and exhaust , and postoperative complications were recorded .Results Enhanced levels of serum PRL were observed in all groups 24 and 48 hours after operation (P<0.05 or P<0.01), in which the increase was more remarkable in the PCEA and PCIA groups than in the control group.The VASs of the PCEA and PCIA groups were greatly lowered than that in the control group (P<0.01). Earlier exhaust was observed in the PCEA group than the PCIA group and the control group (P<0.05).First lactation was earlier seen in the PCEA and PCIA groups than the control (P<0.05).Conclusion Both PCEA with 0.125%ropivacaine and PCIA with sufentanil are safe and effective for postoperative pain control , which can stimulate the secre-tion of PRL and facilitate early lactation .