硬膜外自控镇痛泵对瘢痕子宫剖宫产术后产妇胃肠功能及泌乳的影响  

Effects of patient-controlled epidural analgesia pump on the gastrointestinal function and lactation of patients with scarred uterus after cesarean section

作　　者：王晓超 张晓旭 陈云 FANG Xiaochao;ZHANG Xiaoxu;CHEN Yun(Department of Gynaecology and Obstetrics,Hospital for Maternal and Child Health of Guangyang District,Hebei,Langfang 065000,China)

机构地区：[1]河北省廊坊市广阳区妇幼保健院妇产科,065000 [2]河北省廊坊市第三人民医院检验科

出　　处：《河北医药》2018年第18期2770-2773,2777,共5页Hebei Medical Journal

基　　金：河北省卫生和计划生育委员会科研基金项目(编号:20170236)

摘　　要：目的观察硬膜外自控镇痛泵对瘢痕子宫剖宫产术后产妇胃肠功能及泌乳的影响。方法将114例瘢痕子宫产妇为研究对象,将其随机分为对照组(n=52)和观察组(n=62)。对照组于产后疼痛剧烈难忍时给予盐酸哌替啶注射液肌内注射。观察组手术结束时硬膜外导管接自控镇痛泵,48 h后拔管。比较2组疼痛程度视觉模拟评分(VAS)、舒适度评分(BCS)、血清胃肠激素[胃动素(MLT)、血管活性肠肽(VIP)、胃泌素(GAS)]、胃电参数(正常慢波节律比、胃电频率及胃电主功率)、血清泌乳素(PRL)水平变化,记录2组产妇初乳及首次排气时间。结果产后24 h,观察组产妇疼痛VAS评分较组产后12 h显著下降,48 h较24 h下降,差异有统计学意义(P<0.05)。而对照组产后24 h疼痛VAS评分较12 h无明显变化(P>0.05),48 h后显著下降(P<0.05)。观察组产后24、48 h VAS评分低于对照组(P<0.05)。观察组产后12、24、48 h舒适度评分情况显著高于对照组(P<0.05)。2组产妇术后24 h正常慢波节律比、胃电频率及胃电主功率均较本组术前降低(P<0.05),但对照组较观察组降低更明显(P<0.05)。术后72 h 2组正常慢波节律比、胃电频率及胃电主功率均较本组术后24 h升高(P<0.05),但观察组较对照组更高(P<0.05)。2组产妇术后24 h胃肠激素GAS、MTL水平均较本组术前降低,VIP水平升高,差异均有统计学意义(P<0.05),但对照组较观察组变化更明显(P<0.05)。术后72 h 2组GAS、MTL水平升高,VIP水平降低差异有统计学意义(P<0.05),且观察组与对照组比较差异有统计学意义(P<0.05)。2组产妇产后PRL水平差异无统计学意义(P>0.05)。术后24、48 h均较本组术前升高,且观察组高于对照组(P<0.05)。2组产妇产后初乳及首次排气时间比较差异有统计学意义(P<0.05),观察组早于对照组。结论硬膜外自控镇痛泵对瘢痕子宫剖宫产术后产妇能够有效改善胃肠功能紊乱,促进泌乳。Objective To investigate the effects of patient-controlled epidural analgesia（PCEA） pump on the gastrointestinal function and lactation of patients with scarred uterus after cesarean section. Methods A total of 114 parturients with scarred uterus were randomly divided into control group（n = 52） and observation group（n = 62）. The parturients in control group received intramuscular injection of pethidine hydrochloride when the postpartum pain was severe and unbearable. In the observation group,the epidural catheter was connected to a PCEA pump at the end of the operation,and the tube was removed after 48 h. The changes in visual analog pain scale（VAS）,Bruggrmann comfort scale（BCS）,serum gastrointestinal hormone [motilin（MLT）,vasoactive intestinal peptide（VIP）,gastrin（GAS） ],gastric electrical parameters（percentage of normal slow wave rhythm,electron main frequency and electron main duty of stomach）,and serum prolactin（PRL） levels were observed and compared between the twp groups. Moreover the colostrum secretion time and first exhaust time were recorded in the two groups. Results At 24 h after birth,the VAS scores of parturients in observation group were significantly lower than those at 12 h after birth,which were significantly lower than those at 48 h after birth（P〈0. 05）.In control group,the VAS score at 24 h after birth were not significantly different from those at 12 h after birth（P〈0. 05）,which were decreased significantly after 48 h（P〈0. 05）. The VAS scores in observation group at 24 h and 48 h after birth were significantly lower than those in control group（P〈0. 05）. The scores of BCS in observation group at 12 h,24 h,and 48 h after birth were significantly higher than those in control group（P〈0. 05）. At 24 h after operation,the percentage of normal slow wave rhythm,electron main frequency and electron main duty of stomach in both groups were significantly lower than those before operation（P〈0. 05）,however,those indexes in control

关 键 词：硬膜外自控镇痛泵 瘢痕子宫 剖宫产 胃肠激素 泌乳 

分 类 号：R916.64[医药卫生—药学]