硬膜外麻醉分娩镇痛对初产妇产后母乳喂养及盆底功能的影响

程梅　郑彩虹

[关键词] 硬膜外麻醉;分娩镇痛;初产妇;产后母乳喂养;盆底功能

[中图分类号] R714.3          [文献标识码] B          [文章编号] 1673-9701（2021）19-0132-04

The effect of epidural analgesia during labor on postpartum breastfeeding and pelvic floor function in primiparas

CHENG Mei   ZHENG Caihong

Department of Anesthesiology，Hangzhou Obstetrics and Gynecology Hospital，Hangzhou   310008，China

[Abstract] Objective To study the effect of epidural analgesia during labor on postpartum breastfeeding and pelvic floor function of primiparas. Methods A total of 120 primiparas admitted to our hospital from January 2017 to December 2019 were selected as the research objects.According to the different anesthesia and analgesia methods，they were divided into the fentanyl group，sufentanil group，and non-delivery analgesia group，with 40 cases in each group.The breastfeeding status，the initial time of lactation，the number of feedings within 72 hours of the newborn，and the pelvic floor function of the three groups were compared. Results The breastfeeding rate of primiparas was 62.5% （25/40） in the sufentanil group， 45.0% （18/40） in the fentanyl group， and 30.0% （12/40） in the non-labor analgesia group.The breastfeeding rate of the sufentanil group was higher than that of the fentanyl group and the non-labor analgesia group，and the difference was statistically significant （P=0.001， 0.004）. The initial lactation time and the number of infant feedings of newborns within 72 hours in the sufentanil group were higher than those of the fentanyl group and the non-labor analgesia group.The pelvic floor function indexes of the primiparas in the sufentanil group were higher than those of the fentanyl group and the non-labor analgesia group， showed that the differences were statistically significant （P<0.05）. Conclusion Epidural analgesia after delivery given to primiparas can increase the breastfeeding rate of the mothers，promote the gradual secretion of breast milk， and will not seriously affect the pelvic floor function of the mothers. It is worthy of clinical promotion.

[Key words] Epidural anesthesia; Labor analgesia; Primipara; Postpartum breastfeeding; Pelvic floor function

分娩主要是指胎儿脱离女性体内的子宫部位，并成为独立个体的主要阶段及过程[1]。女性分娩的全过程主要分为三个不同的阶段，这三个阶段也常被称为三个产程，第一产程是宫口扩张阶段，第二产程是胎儿娩出的阶段，第三阶段也就是最后的階段，即胎盘娩出阶段[2-3]。但是，女性在分娩的过程中极易由于剧烈的疼痛感，致使产妇出现加大的心理压力及生理压力[4]。并且，女性分娩过程中由于疼痛感的刺激极易发生一系列的应激反应，致使女性的交感神经处于活跃的状态，促使机体分泌出茶酚胺类物质，从而发生宫缩抑制的情况，严重影响产妇的正常分娩，甚至部分情况严重的时候，还会导致产妇体内的胎儿发生宫内窘迫的情况[5]。并且，分娩作为女性需要经历的自然生育环节，在女性妊娠的阶段内，器官、免疫及内分泌等都会发生对应的变化，促使机体处于较为特殊的生理状态中[6]。而女性在分娩过程中发生的剧烈疼痛，不仅会增加女性身心痛苦，还会加大女性的心理压力，再加上由于分娩较为痛苦，强烈的疼痛刺激感会导致女性发生子宫脱垂、尿失禁等情况，严重影响着女性的盆底功能。硬膜外麻醉作为一种比较常见的麻醉分娩方法，但关于此种治疗方法对女性盆底功能的影响报道则比较少。基于此，本研究通过给予其不同的镇痛方法，分析硬膜外麻醉分娩镇痛对初产妇分娩之后母乳喂养以及盆底功能的影响，现报道如下。