硬膜外麻醉分娩鎮痛對初產婦產后母乳喂養及盆底功能的影響

程梅　鄭彩虹

[關鍵詞] 硬膜外麻醉;分娩鎮痛;初產婦;產后母乳喂養;盆底功能

[中圖分類號] R714.3? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 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

分娩主要是指胎兒脫離女性體內的子宮部位，并成為獨立個體的主要階段及過程[1]。女性分娩的全過程主要分為三個不同的階段，這三個階段也常被稱為三個產程，第一產程是宮口擴張階段，第二產程是胎兒娩出的階段，第三階段也就是最后的階段，即胎盤娩出階段[2-3]。但是，女性在分娩的過程中極易由于劇烈的疼痛感，致使產婦出現加大的心理壓力及生理壓力[4]。并且，女性分娩過程中由于疼痛感的刺激極易發生一系列的應激反應，致使女性的交感神經處于活躍的狀態，促使機體分泌出茶酚胺類物質，從而發生宮縮抑制的情況，嚴重影響產婦的正常分娩，甚至部分情況嚴重的時候，還會導致產婦體內的胎兒發生宮內窘迫的情況[5]。并且，分娩作為女性需要經歷的自然生育環節，在女性妊娠的階段內，器官、免疫及內分泌等都會發生對應的變化，促使機體處于較為特殊的生理狀態中[6]。而女性在分娩過程中發生的劇烈疼痛，不僅會增加女性身心痛苦，還會加大女性的心理壓力，再加上由于分娩較為痛苦，強烈的疼痛刺激感會導致女性發生子宮脫垂、尿失禁等情況，嚴重影響著女性的盆底功能。硬膜外麻醉作為一種比較常見的麻醉分娩方法，但關于此種治療方法對女性盆底功能的影響報道則比較少。基于此，本研究通過給予其不同的鎮痛方法，分析硬膜外麻醉分娩鎮痛對初產婦分娩之后母乳喂養以及盆底功能的影響，現報道如下。