经皮穴位电刺激分娩镇痛临床观察

Clinical Observation of Transcutaneous Electrical Acupoint Stimulation for Labor Analgesia

目的:观察经皮穴位电刺激(TEAS)在分娩镇痛过程中的应用效果。方法:回顾性分析在本院进行分娩的120例产妇的病历资料,根据是否接受分娩镇痛及分娩镇痛方式分为TEAS组、锥管内麻醉组与空白组,每组40例。TEAS组在产妇子宫收缩活跃后于相应穴位进行电刺激直至胎儿分娩,锥管内麻醉组使用盐酸瑞芬太尼0.2～0.5 g/kg注入椎管的蛛网膜下腔或硬膜外腔,连续泵入直至第二产程结束,空白组不给予任何镇痛处理。对3组产妇分娩过程中的疼痛情况、不同产程时间、分娩方式及分娩过程中的出血量进行统计与对比。结果:与产前比较,TEAS组、锥管内麻醉组镇痛后及产时VAS评分与TEAS组宫缩活跃期末VAS评分均降低(P <0.05),锥管内麻醉组宫缩活跃期末VAS评分与产前相当(P> 0.05)。3组镇痛后不同时间点VAS评分比较,差异均有统计学意义(P <0.05)。镇痛后、宫缩活跃期末和产时,TEAS组及锥管内麻醉组VAS评分均低于空白组(P <0.05);TEAS组VAS评分低于锥管内麻醉组(P <0.05)。TEAS组与锥管内麻醉组产妇总产程、第一产程、第二产程和第三产程均短于空白组(P <0.05)。TEAS组总产程、第一产程、第二产程、第三产程与锥管内麻醉组比较,差异均无统计学意义(P> 0.05)。与空白组比较,TEAS组自然分娩率较高,剖宫产率较低,差异均有统计学意义(P <0.05)。与锥管内麻醉组比较,TEAS组自然分娩率较高,差异有统计学意义(P <0.05)。3组产钳助产率比较,差异无统计学意义(P> 0.05)。空白组及锥管内麻醉组的分娩方式比较,差异无统计学意义(P> 0.05)。3组产妇分娩过程的出血量比较,差异无统计学意义(P> 0.05)。结论:TEAS可优化分娩阵痛效果,促进自然分娩,值得临床推广。

Objective:To observe the application effect of transcutaneous electrical acupoint stimulation(TEAS) for labor analgesia. Methods:Retrospective analysis 120 cases of parturient women who gave birth in our hospital, and divided them into the TEAS group,the intrathecal anesthesia group and the blank group according to analgesia methods,40 cases in each group. After the active uterine contraction of parturient women,the TEAS group received electrical stimulation at certain acupoints till delivery;the intrathecal anesthesia group received remifentanil hydrochloride (0.2 to 0.5 g/kg) via continuous infusion into the subarachnoid of spinal canal or the epidural space till the end of the second stage of labor; the blank group received no analgesia. Statistically analyzed and compared the status of pain during delivery and the blood loss in different stages of labor,through different methods of delivery and during delivery of parturient women in each group. Results:Comparing with those before delivery,scores of VAS in the TEAS group after analgesia, during delivery and in the end of active uterine contraction were decreased(P<0.05),scores of VAS in the intrathecal anesthesia group after analgesia and during delivery were decreased(P<0.05),and scores of VAS in the intrathecal anesthesia group in the end of active uterine contraction were relatively equal to those before treatment(P>0.05). Comparing the scores of VAS at different time points after analgesia in the three groups,there were significant differences being found(P<0.05). After analgesia,in the end of active uterine contraction and during delivery,scores of VAS in the TEAS group and the intrathecal anesthesia group were respectively lower than those in the blank group(P<0.05);scores of VAS in the TEAS group were lower than those the intrathecal anesthesia group(P<0.05). The total stage of labor,the first,second and third stages of labor in the TEAS group and the intrathecal anesthesia group were all shorter than those in the blank group(P<0.05). Comparing the total stage of labor,the first,second and third stages of labor in the TEAS group with those in the intrathecal anesthesia group,there were no significant differences being found(P>0.05). Comparing with the blank group,the rate of natural delivery in the TEAS group was the highest,and the cesarean section rate was relatively lower, differences being significant(P<0.05). Comparing with the intrathecal anesthesia group,the rate of natural delivery in the TEAS group was relatively higher,differences being insignificant(P<0.05). Comparing the forceps delivery rate among the three groups,there was no significant difference being found(P>0.05). There was no significant difference being found in the methods of delivery between the blank group and the intrathecal anesthesia group(P>0.05). Comparing the blood loss during delivery among the three groups,there was no significant difference being found(P>0.05). Conclusion:TEAS can optimize the effect of labor analgesia and promote the natural delivery,which is worthy of clinical promotion.