国际麻醉学与复苏杂志   2012, Issue (9): 8-8
    
剖宫产术后硬膜外镇痛对产妇催乳素及新生儿神经行为的影响
罗小玲, 朱绪亮, 袁中草, 李秀珍, 谢伦雄, 张本军, 夏恒夫1()
1.广东省深圳市盐田区人民医院或深圳市第七人民医院
Effects of postoperative epidural analgesia on prolactin level and neonatal neurobehavioral scores after caesarean section
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摘要：

目的　研究布托啡诺复合左布比卡因在剖宫产术后硬膜外镇痛对产妇泌乳及新生儿神经行为的影响。方法 选择剖宫产产妇60例，按术后镇痛方式不同分为3组(B、M、C组，每组20例)， B组：0.006%布托啡诺+0.15%左布比卡因；M组：0.004%的吗啡+0.15%左布比卡因；C组：术后疼痛时采用盐酸哌替啶肌注镇痛（1 mg/kg）。B、M组采用连续硬膜外镇痛。术后进行视觉模拟评分（VAS）并记录恶心、呕吐等副作用发生率，测产妇血清催乳素（prolactin, PRL）浓度并记录产后初乳时间，进行新生儿神经和适应能力评分（NACS）。结果B组[4 h:(1.1±0.7),8 h:(1.2±1.2),12 h:(1.7±1.1),24 h:(1.4±1.5),48 h:(1.0±0.9)]、M组[4 h: (1.1±0.9),8 h: (1.3±1.9),12 h: (1.6±1.2),24 h: (1.3±1.3),48 h: (1.0±0.7)]的VAS评分明显低于C组[4 h:(2.2±1.3),8 h:(4.3±1.7),12 h:(4.7±1.5),24 h:(3.6±1.3),48 h:(2.4±1.1)]（P﹤0.05），但M组恶心呕吐（30%）、瘙痒（25%）等副作用要明显高于B组(分别为: 3%,0%)（P﹤0.05），B组(26±8) h、M组(26±9) h泌乳时间要早于C组(35±10) h（P﹤0.05），且B组[分别为: (357±62)、(387±63)μg/L]、M组[分别为: (367±64)、(392±61)μg/L]术后24、48 h PRL明显高于术前[B组: (220±59)μg/L, M组:(238±70)μg/L]及C组[分别为: (299±93)、 (327±74)μg/L]，而B、M差异无统计学意义，3组NACS比较无统计学意义。结论 布托啡诺复合左布比卡因用于剖宫产术后硬膜外镇痛效果好、副作用少且可促进产妇泌乳，对新生儿神经行为无明显影响。
关键词： 布托啡诺；剖宫产术；硬膜外镇痛；催乳素；新生儿
Abstract:

Objective To investigate the effect of postoperative epidural analgesia on prolactin level and neonatal neurological and adaptive capacity scores(NACS) after caesarean section. Methods Sixty healthy primipara after caesarean section under combined spinal epidural anesthesia were randomly divided into three groups(n=20). Received epidural analgesia with complex of butorphanol (0.006%) and levobupivacaine(0.15%) in group B, those with morphine(0.004%) and levobupivacaine(0.15%) in group M. Group C was given conventional postoperative analgesia with meperidine injection. The visual analog scales (VAS) and the adverse effects were observed at 4,8,12, 24 and 48 h after operation. Detect the prolactin (PRL) level in serum before operation, after operation 24 h and 48 h separately by electrochemiluminescence immunoassay(ECLI). Keep note of the first lactation time. NACS was recorded at 24, 48 and 72 h. Results The VAS was significantly lower in group B[4 h:(1.1±0.7),8 h:(1.2±1.2),12 h:(1.7±1.1),24 h:(1.4±1.5),48 h:(1.0±0.9)]and group M[4 h: (1.1±0.9),8 h: (1.3±1.9),12 h: (1.6±1.2),24 h: (1.3±1.3),48 h: (1.0±0.7)] than that in group C[4 h:(2.2±1.3),8 h:(4.3±1.7),12 h:(4.7±1.5),24 h:(3.6±1.3),48 h:(2.4±1.1)]at all time points (P<0.05). The adverse effects of pruritus, nausea and vomiting were significantly more in group M(25%,30%,respectively) than that in group B(5%,0%,respectively) (P<0.05). The first lactation time of the group B(26±8) h and M(26±9) h were distinctively earlier than that of the group C(35±10) h (P<0.05). The PRL concentration in serum of the group B[(357±62), (387±63)μg/L,respectively] and groupM[(367±64), (392±61)μg/L,respectively] at 24h, 48 h after operation were higher than that of the group C[(299±93), (327±74) μg/L, respectively] (P<0.05). There was no significant difference NACS among the 3 groups. Conclusions Combined with Butorphanol levobupivacaine, epidural analgesia in parturient after cesarean section can provide effective analgesia, with less pruritus, nausea and vomiting, and promoting lactation without untoward reaction on NACS.
Key words: Butorphanol; Caesarean section; Epidural analgesia; Prolactin; Neonatal