潜伏期电针镇痛对分娩产妇应激及硬膜外镇痛效果的影响

The Effect of Latent Electroacupuncture Intervention on Maternal Stress and Epidural Labor Analgesia

目的探讨潜伏期电针镇痛对产妇应激激素及对硬膜外镇痛效果的影响。方法纳入2016年1月-2018年6月初产妇104例按随机数字表法分为三组:A组(电针+硬膜外阻滞)n1=37;B组(假电针+硬膜外阻滞)n2=36;C组(单纯硬膜外阻滞)n3=31。A组于宫口开至1 cm时用韩式穴位神经刺激仪刺激合谷、三阴交穴针刺镇痛直至活跃期开始(宫口3 cm);B组同A组,但为假针刺激;C组无电针干预,三组均于宫口3 cm时行硬膜外阻滞并自控硬膜外镇痛。记录电针即刻(T0)、电针后1 h(T1)、电针后2 h(T2)、硬膜外阻滞即刻(T3)、硬膜外阻滞后1 h(T4)、硬膜外阻滞后2 h(T5)、宫口开全时(T6)视觉模拟评分(VAS),于T1-T3、T6抽取产妇静脉血检测促肾上腺皮质激素(ACTH)、皮质醇(COR)浓度,记录自控镇痛泵有效按压和总按压次数、舒芬太尼、罗哌卡因用量。结果(1)三组T0 VAS无显著性差异(P>0.05);(2)组间VAS比较:A组T1-T6各时间点与B组、C组相比VAS明显降低,差异有统计学意义(P<0.05);(3)组内VAS比较:A组T1-T6各时间点VAS显著低于T0,有统计学差异(P<0.05),B、C两组T4-T6 VAS较T0明显降低,差异有统计学意义(P<0.05);(4)药物用量比较:B组、C组镇痛泵有效按压和总按压次数、舒芬太尼、罗哌卡因用量均较A组产妇多,差异有统计学意义(P<0.05);(5)ACTH、COR浓度比较:三组T2、T3、T6 ACTH、COR浓度较T1明显升高,有统计学意义(P<0.05),且随产程进展其浓度逐渐增加,但A组T2、T3、T6较B、C两组显著降低,有统计学差异(P<0.05)。结论潜伏期电针分娩镇痛可有效减轻产妇疼痛,抑制产妇应激反应,增强硬膜外阻滞分娩镇痛疗效,减少硬膜外阻滞药物用量,两者联合使用可安全用于全产程镇痛,使潜伏期和活跃期产妇镇痛能形成有效衔接。

Objective To investigate the effect of latent electroacupuncture intervention on maternal stress hormones and epidural labor analgesia.Methods A total of 104 primiparous women were enrolled in this study from January 2016 to June 2018.The patients were divided into three groups according to the random number table:group A(electroacupuncture and epidural block)n1=37;group B(sham electroacupuncture and epidural block))n2=36;group C(simple epidural block)n3=31.When the cervical dilatation was 1 cm,group A was stimulated at Hegu(LI-4)and Sanyinjiao(SP-6)by Korean acupoint nerve stimulator until the active phase began(cervical dilatation was 3 cm);Group B was performed sham electroacupuncture stimulation at the same acupoints;Group C was received simple epidural block without electroacupuncture intervention.All three groups were received epidural block and controlled epidural analgesia at 3 cm of the cervical dilatation.Visual analogue scale(VAS)was recorded at immediate electroacupuncture(T0),1 h after electroacupuncture(T1),2 h after electroacupuncture(T2),immediate epidural block(T3),epidural blockade lag 1 h(T4),epidural block lag 2 h(T5),cervical dilatation fully opening(T6).Maternal venous blood was extracted from T1-T3 and T6 to detect the concentrations of adrenocorticotrophic hormone(ACTH)and cortisol(COR).The effective compression,total compression times,sufentanil and ropivacaine dosage of the controlled analgesia pump were recorded.Results(1)There was no significant difference in T0 VAS among the three groups(P>0.05).(2)Comparison of VAS between groups:The VAS of T1-T6 in group A was significantly lower than that in group B and C(P<0.05);(3)Comparison of VAS in the group:In group A,VAS at T1-T6 was significantly lower than T0.(P<0.05).T4-T6 VAS in group B and group C were significantly reduced compared with T0(P<0.05);(4)Comparison of drug dosage:Effective compression,total compression times,sufentanil and ropivacaine dosage of the controlled analgesia pump in group B and group C were dramatically more than those in group A(P<0.05).(5)Comparison of ACTH and COR concentrations:the concentrations of ACTH and COR at T2,T3,T6 in the three groups were significantly higher than those in T1(P<0.05).The concentration was gradually increased with the progress of labor,and the concentrations of ACTH and COR at T2,T3 and T6 in group A were significantly lower than those of group B and C(P<0.05).Conclusion Latent electroacupuncture labor analgesia can effectively alleviate maternal pain,inhibit maternal stress response,increase the effect of epidural labor analgesia,and reduce the dosage of epidural block.The combination of latent electroacupuncture and epidural block can be safely used for analgesia during the whole stages of labor,thus the incubation period and the active period of maternal analgesia can form an effective connection.