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1、剖宫产术后硬膜外镇痛对母乳喂养新生儿精神行为能力影响【摘要】目的观察剖宫产术后应用吗啡类硬膜外镇痛对母乳喂养及新生儿精神行为能力的影响。方法选择ASAI-II级足月妊娠剖宫产孕妇120例,随机分为镇痛I组、镇痛II组和对照组。结果两镇痛组镇痛效果满意,对呼吸、循环功能无明显影响。两镇痛组产后24h开奶例数、产后24h哺乳3~8次例数明显高于对照组(P0.05)。结论剖宫产术后应用吗啡类硬膜外患者自控镇痛效果可靠,并能降低术后产妇的应激反应,消除疼痛导致的焦虑、紧张等情绪反应,促进早开奶,利于母乳喂养,对母乳喂养
2、的新生儿精神行为无明显不良影响,可安全应用于临床。【关键词】硬膜外,镇痛;吗啡;母乳喂养;新生儿;神经病理学检查Effectofepiduralanalgesiaonbreast-feedingandnewbornenergeticadaptivecapacityinparturientscesareansectionZHOUChuan-hua,CAIYe-ping,LIANGJian-hua.Departmentofanesthesiology,maternalandchildhealthhospital,d
3、uanzhouArea,guangdong,Zhaoqing526040,China5【Abstract】ObjectiveToevaluateepiduaralanalgesia(PCEA)withmorphineonbreast-feedingandnewbornenergeticadaptivecapacityinparturientscesareansection.MethodsChoosesASAtheI-IIlevelfull-termpregnancywoman120examplesafterce
4、sareansection,dividesintostochasticallyeasesthepainIgroup,easesthepainIIlevelofandthecontrolgroup.ResultsTwoanalgesiagroupanalgesiceffectissatisfied,tobreathes,theloopfunctionaffectsnotobviously.Twoanalgesiagrouppost-natal24hopensthemilkexamplenumber,post-na
5、tal24hnurses3-8timeexamplenumbertobehigherthanthecontrolgroupobviously(P0.05).ConclusionCesareansectionandpostoperativepatientcontrolledepiduralmorphineanalgesiacanbereliable,andcanreducetheparturientsstresstorespond,eliminatestheachetocauseanxious,andsoonth
6、emoodtorespond,thepromotionopensthemilkearly,favorsbreast-feeding.ThePCEAwithmorphinementionedabovecanbesafeforneonatesinparturientsaftercesareansection.5【Keywords】Epiduralanalgfsia;Morphine;Breast-feeding;Newborn;Neurologicalexamination作者单位:526040广东省肇庆市端州区妇
7、幼保健院麻醉科分娩或剖宫产后的疼痛及焦虑、营养欠佳、镇静或镇痛药应用均可抑制产妇乳汁分泌[1,2]。剖宫产术后硬膜外吗啡镇痛已广为临床应用,研究表明,其镇痛效果明显优于以往间断肌肉注射镇痛药镇痛的常规方法,而且也有助于术后肠蠕动的恢复[1,2]。本文究其对婴儿母乳喂养有何帮助及影响作一临床研究。1资料与方法1.1一般资料选择无严重产科合并症初产妇120例,年龄23~35岁,体重(60±7)kg,孕期38~42周,无乳房发育缺陷及内分泌疾病。行腰麻和硬膜外联合麻醉,穿刺点选择L��2~3�或L��3~4�椎间隙。
8、先缓慢注入0.5%布比卡因1.4~1.6ml,行腰麻,然后向头端置入硬膜外导管3cm,6min后测试麻醉平面不足者硬膜外腔给予2%利多卡因2~3ml试验量,然后酌情追加药物。术中不用辅助药,麻醉效果满意。1.2术后镇痛术后将产妇随机分为三组。镇痛I组,吗啡6mg+氟哌利多2.5mg+0.9%氯化钠注射液至100ml;镇痛II组罗哌卡因150mg+芬太尼0.35mg+0.9%氯化钠注射液
