硬膜外分娩镇痛对新生儿早期吸吮和母乳喂养的影响  

Effects of epidural labor analgesia on early neonatal sucking and breastfeeding

作　　者：张洁[1] 陈志芳[1] Zhang Jie;Chen Zhifang(Department of Obstetrics,the Affiliated Maternity and Child Health Care Hospital of Nantong University,Nantong 226018,China)

机构地区：[1]南通大学附属妇幼保健院产科,南通226018

出　　处：《中华围产医学杂志》2024年第3期196-202,共7页Chinese Journal of Perinatal Medicine

基　　金：江苏省南通市科技计划(MS12021040)。

摘　　要：目的探讨硬膜外分娩镇痛对新生儿吸吮能力和母乳喂养的影响。方法采用前瞻性队列研究设计,研究对象为2022年1月至2022年12月在南通大学附属妇幼保健院分娩的产妇。按是否选择硬膜外分娩镇痛,将其分为硬膜外镇痛组和未镇痛组。采用吸吮负压测量仪在新生儿生后3 d内每天测量新生儿吸吮母亲乳头时的口腔负压,记录吸吮负压均值、峰值和谷值。采用中文版婴儿母乳喂养评估工具(Infant Breastfeeding Assessment Tool,IBAT)评估新生儿吸吮姿势。记录并随访产妇在院期间和出院后第1、4、6个月的母乳喂养情况。采用两独立样本t检验、χ^(2)检验(或Fisher精确概率法)及广义估计方程等方法对数据进行统计分析。结果共156例产妇纳入最终分析,2组各78例。镇痛组比未镇痛组产妇的总产程、第一产程和第二产程时间更长[M(P_(25)~P_(75)),430 min(353~541 min)与300 min(235~422 min),Z=-5.65;385 min(310~490 min)与260 min(205~347 min),Z=-5.81;40 min(26~67 min)与33 min(18~45 min),Z=-2.33;P值均<0.05],产前使用催产素和选择导乐分娩者更多[94.8%(74/78)与43.6%(34/78),χ^(2)=48.15;42.3%(33/78)与19.2%(15/78),χ^(2)=9.75;P值均<0.05]。2组产妇的产后疲乏、抑郁和睡眠情况,以及孕期生活事件量表评分的差异均无统计学意义。广义估计方程分析控制混杂因素后,镇痛组新生儿生后3 d内(0~24 h、>24~48 h、>48~72 h)中位吸吮负压均值低于未镇痛组[分别为5.14 kPa(3.39~6.52 kPa)与6.39 kPa(4.95~9.15 kPa)、5.07 kPa(3.94~7.38 kPa)与6.20 kPa(5.08~8.54 kPa)和6.19 kPa(4.64~8.36 kPa)与6.81 kPa(5.88~8.05 kPa),Waldχ^(2)=5.59,P=0.018];峰值也低于未镇痛组[15.81 kPa(9.74~21.68 kPa)与16.21 kPa(13.58~24.88 kPa)、13.50 kPa(9.83~16.50 kPa)与17.62 kPa(14.01~22.40 kPa)和14.66 kPa(10.47~18.71 kPa)与18.04 kPa(15.33~19.85 kPa),Waldχ^(2)=7.25,P=0.007];谷值在2组间差异无统计学意义。镇痛组新生儿生后3 d内每天吸吮姿势的IBAT得分低Objective To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding.Methods This was a prospective cohort study.Convenience sampling was used to enroll women who delivered with or without epidural analgesia(epidural analgesia and non-analgesia groups)in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022.Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth(0-24 h,>24-48 h,and>48-72 h),and the mean,maximum,and minimum pressure values were recorded.The Infant Breastfeeding Assessment Tool(IBAT)(Chinese version)was used to evaluate sucking posture.Breastfeeding status during hospitalization and within 1,4,and 6 months after discharge were followed up.Two independent samples t-test,Chi-square(Fisher's exact)test,and generalized estimating equations were used for data analysis.Results A total of 156 mother-infant pairs were analyzed in this study,with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group.The whole,first,and second stages of labor were longer in the analgesia group than those in the non-analgesia group[M(P_(25)-P_(75)),total:430 min(353-541 min)vs.300 min(235-422 min),Z=-5.65;first stage:385 min(310-490 min)vs.260 min(205-347 min),Z=-5.81;second stage:40 min(26-67 min)vs.33 min(18-45 min),Z=-2.33;all P<0.05],and more women in the analgesia group accepted oxytocin and doula before delivery[94.8%(74/78)vs.43.6%(34/78),χ^(2)=48.15;42.3%(33/78)vs.19.2%(15/78),χ^(2)=9.75;both P<0.05].There was no significant difference in scores on the Fatigue Scale-14,Edinburgh Postnatal Depression Scale,Pittsburgh Sleep Quality Index,and Life Events Scale for Pregnant Women between the two groups.After adjusting for confounding factors by generalized estimating equations,the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h,>24-48 h,and

关 键 词：镇痛 硬膜外 镇痛 产科 吸吮行为 自我效能 母乳喂养 婴儿 新生 

分 类 号：R714.3[医药卫生—妇产科学] R174.4[医药卫生—临床医学]