剖宫产术后硬膜外镇痛产妇血及初乳中吗啡含量的监测  

Concentrations of Morphine in Colostrum and Plasma During Postcesarean Epidural Anesthesia

作　　者：王瑛[1] 要小梅[1] 龙棣[1] 吴庆庆[1] 辛勤[1] 

机构地区：[1]首都医科大学附属复兴医院妇产科,100038

出　　处：《中华围产医学杂志》2003年第3期138-140,共3页Chinese Journal of Perinatal Medicine

摘　　要：目的　监测剖宫产术后硬膜外镇痛产妇血及初乳中的吗啡含量 ,探讨微量吗啡对新生儿的影响。　方法　选择剖宫产术的产妇 10 0例 ,分为实验组和对照组各 5 0例 ,两组均为连续硬膜外麻醉 ,穿刺点选择 L1 ～ L3,麻醉药为 2 %利多卡因 15～ 2 0 m l,在手术结束时 ,实验组将吗啡缓慢注入硬膜外管 2 mg然后拔管。于术后 1h取产妇的静脉血 3m l,采集产妇术后 3、6 h尿样及术毕 6～ 12 h采集新生儿尿样 3m l;在产后 4 8h内收集产妇的初乳 3～ 5 m l。　结果　观察组 96 % (48/ 5 0 )的镇痛效果较对照 16 % (8/ 5 0 )明显 ,差异有显著性 (P<0 .0 5 ) ,观察组血吗啡浓度 <5～ 118μg/ m l,初乳吗啡浓度 <5～ 30 .4μg/ L ,产妇尿 92 %呈阳性 ,新生儿尿 13.3%呈阳性。两组产妇和新生儿的生命体征比较差异无显著性。　结论　剖宫产术后硬膜外腔应用吗啡镇痛 ,产妇哺乳对新生儿没有影响 ,是安全可行的。Objective To study the effect of morphine used in epidural anesthesia on puerpera after cesarean section and the safety of morphine to neonate. Method One hundred puerpera undergone cesarean section were randomly divided into test group and control group with continuous 2% lidocaine epidural anesthesia, as soon as the operation were finished, 2 mg morphine was injected into vacum epidurale for test group, nothing for control group. Colostrum and plasma, urine samples of puerpera and neonate were collected, morphine and metabolite level were tested by GC-MS and FPIA. Result Morphine concentrations ranged from <5 to 118 μg/L,in plasma, and <5 to 30.4 μg/L in milk. The analgesia effect is obviously better in test group ( P <0.05), and there were no statistical difference of the respiration rate, heart rate, blood pressure between the two groups( P >0.05). Conclusion As the epidural analgesia medicine after cesarean section, morphine has no side-effect to neonate and is safe to neonate.

关 键 词：剖宫产 术后镇痛 硬膜外麻醉 产妇 血 初乳 吗啡 含量监测 

分 类 号：R719.8[医药卫生—妇产科学] R614.42[医药卫生—临床医学]