Kochenour N K
Clin Obstet Gynecol. 1980 Dec;23(4):1045-59. doi: 10.1097/00003081-198012000-00008.
In spite of a very recent upsurge in breast-feeding in industrialized countries, approximately one-half of parturients are candidates for postpartum lactation suppression. The mechanisms controlling lactation are complex and involve preparation of the breast during pregnancy, stimulation of secretion of milk in the immediate postpartum period, ejection of milk from the alveolar cells, and maintenance of milk production during the period od lactation. The local effects of estrogen and progesterone in the breast prevent milk secretion during pregnancy. With their withdrawal in the postpartum period, the stimulating effect of the anterior pituitary hormone prolactin dominates and milk secretion is initiated and maintained. Milk ejection is accomplished by a neurohormonal reflex resulting in stimulation of the myoepithelial cells of the breast by the posterior pituitary hormone oxytocin. Local stimulation of the breast by suckling is important in initiating the release of oxytocin and also the secretion of prolactin. The suppression of lactation in the postpartum period can be accomplished in approximately 60--70% of females by the use of a tight brassiere and avoidance of stimulation of the nipples. An additional 10% or so of females can be helped with the use of estrogens during the postpartum period. The addition of an androgen to the estrogen increases the success rate of lactation suppression to about 90%. Unfortunately, the use of estrogen alone or in combination with an androgen is accompanied by rebound lactation in a significant number of patients and has been associated with an increased incidence of postpartum thromboembolic disease. Lactation suppression by inhibiting prolactin secretion with synthetic ergot alkaloids such as bromocriptine has been shown to be safe and highly effective both immediately post partum and after lactation has been established. The 2 week period of therapy required with this drug may be unsatisfactory for some patients. If given immediately at delivery, a single injection of testosterone enanthate and estradiol valerate is equally effective in suppressing lactation and, in the young patient who has delivered vaginally, is not associated with significant risk.
尽管工业化国家近期母乳喂养率有所上升，但仍约有一半的产妇需要进行产后泌乳抑制。控制泌乳的机制很复杂，包括孕期乳房的准备、产后即刻乳汁分泌的刺激、乳汁从腺泡细胞的排出以及哺乳期乳汁分泌的维持。雌激素和孕激素在乳房的局部作用可在孕期阻止乳汁分泌。产后它们撤离后，垂体前叶激素催乳素的刺激作用占主导，乳汁分泌开始并得以维持。乳汁排出是通过一种神经激素反射实现的，即垂体后叶激素催产素刺激乳房的肌上皮细胞。哺乳时对乳房的局部刺激对于引发催产素的释放以及催乳素的分泌都很重要。在产后，约60% - 70%的女性通过佩戴紧身胸罩并避免乳头刺激可实现泌乳抑制。另外约10%的女性在产后使用雌激素会有所帮助。在雌激素中添加雄激素可将泌乳抑制的成功率提高到约90%。不幸的是，单独使用雌激素或与雄激素联合使用会使相当多的患者出现泌乳反弹，并且与产后血栓栓塞性疾病的发病率增加有关。用合成麦角生物碱如溴隐亭抑制催乳素分泌来抑制泌乳，已被证明在产后即刻以及泌乳已建立后都是安全且高效的。这种药物所需的2周治疗期对一些患者来说可能不太理想。如果在分娩时立即给药，单次注射庚酸睾酮和戊酸雌二醇在抑制泌乳方面同样有效，而且对于经阴道分娩的年轻患者，没有显著风险。
