地佐辛静脉镇痛对剖宫产术后母乳营养成分变化的影响  

Effect of intravenous analgesia with dezocine on changes of milk composition after cesarean section

作　　者：巩文怡[1] 岳小芳 李士通[3] 徐冰[1] Gong Wenyi;Yue Xiaofang;Li Shitong;Xu Bing(Department of Anesthesiology,Shanghai First People′s Hospital,Baoshan Branch,Shanghai 200940,China)

机构地区：[1]上海市第一人民医院宝山分院麻醉科,200940 [2]上海市第六人民医院东院麻醉科 [3]上海交通大学附属第一人民医院麻醉科

出　　处：《山西医药杂志》2019年第20期2459-2462,共4页Shanxi Medical Journal

基　　金：国家自然科学基金（31400953）;上海市宝山区科委科技创新专项资金项目（16-E-5）

摘　　要：目的评价地佐辛静脉镇痛对剖宫产术后泌乳及母乳营养成分变化的影响。方法选择阴道分娩产妇(V组)20例,急诊行剖宫产+地佐辛静脉镇痛产妇(C组)20例,评价2组产妇泌乳情况、新生儿神经和适应能力评分(NACS),测定产后0~216 h母乳中蛋白质、乳糖、脂肪。结果V组18例,C组19例最终纳入研究。术后48 h泌乳充足产妇V组比C组多(15例,1例)(P<0.01),术后72 h泌乳充足产妇V组比C组多(18例,13例)(P<0.05)。2组产妇新生儿48 h NACS评分均≥35分(P>0.05);产后72 h内和144~216 h 2组比较差异无统计学意义(P>0.05);2组在72~144 h与0~72 h比较和组间比较差异有统计学意义(P<0.05);乳糖浓度比较,在产后0~72 h,组间比较差异有统计学意义(P<0.05),在72~144 h与0~72 h比较差异有统计学意义(P<0.05),但组间比较差异无统计学意义(P>0.05),在144~216 h,组间比较差异无统计学意义(P>0.05);脂肪浓度比较,2组变化差异无统计学意义(P>0.05)。结论地佐辛静脉镇痛仍不能改变剖宫产产妇术后3 d内哺乳量不足的情况,母乳中营养成分浓度及变化略微不同于自然分娩产妇,但在产后6 d使用地佐辛静脉镇痛的产妇和自然分娩产妇相当。Objective To investigate the effect of intravenous analgesia with dezocine on thelactation and nutritional components in breast milk after cesarean section.Methods Twenty women having a vaginal birth(group V)and 20 women having emergency caesarean section with dezocine-PCIA(group C)were approached.The two groups were evaluated for lactation status,neurologic and adaptive capacity scores(NACS)of the infants,and measured for the levels of protein,lactose and fat in breast milk at 0-216 h postpartum.Results Eighteen cases in group V and 19 cases in group C were finally included in the study.Compared with the group C,in group V,there were 14 more women at 48 h(P<0.01)and 5 more women at 72 h after the operation who presented adequate lactation(P<0.05).The 48 h NACS scores in both groups were greater than 35,with no significant difference between the two groups(P>0.05).There was no significant difference between the two groups on protein concentration within 72 h postpartum(P>0.05).During 72-144 h,there was an decrease by 8.9 g/L in group V(P<0.05)and by 13.2 g/L in group C(P<0.05),with group V being 1.7 g/L higher than group C(P<0.05).There was no significant difference between groups during 144 to 216 h(P>0.05).Lactose concentration in group C was lower than that in group V at 0-72 h postpartum(P<0.05).At 72-144 h,the lactose concentration increased by 6.7 g/L in group V(P<0.05)and by10.2 g/L in group C(P<0.05),with no statistically significant between-group difference(P>0.05).There was no significant difference in lactose concentration between groups during 144 to 216 h(P>0.05).There was no significant difference in fat concentration at all time windows within and between the two groups(both P>0.05).Conclusion Intravenous analgesia with dezocine does not change the insufficient breast-feeding within 3 days after cesarean section.The breast milk composition shows certain change in the women who have a cesarean birth with dezocine-PCIA,but is similar to that in women with virginal delivery at 6 days postpartum.

关 键 词：乳 人 母乳喂养 剖宫产术 地佐辛 

分 类 号：R47[医药卫生—护理学]