自控经皮耳神门穴电刺激在焦虑产妇剖宫产术前准备中的应用

Feasibility of the therapy for preoperative preparation of anxiety maternal with patient-controlled transcutaneous electrical stimulation on auricular Shenmen point

目的探讨自控经皮电刺激耳神门穴用于焦虑产妇剖宫产术前准备的可行性。方法选择Zung氏焦虑自评分（SAS）〉30分的择期剖宫产产妇60例，随机分为两组，观察组（n=30）产妇入手术室后行自控穴位电刺激，取耳神门穴，频率为1．5Hz，强度由产妇自己掌握，持续刺激30min。对照组（n=30）不进行电刺激。比较两组产妇入室时（T0）及刺激30min后（T1）的心率（HR）、平均动脉压（MAP）、胎儿心率变化；比较产妇焦虑VAS评分、血浆血管紧张素Ⅱ水平。结果观察组产妇刺激30min后HR为（72±9）次／min，MAP（84±11）mmHg，焦虑VAS评分（49．8±20．8）分，血浆血管紧张素Ⅱ水平（73．9±21．8）ng／L，均低于对照组，差异有统计学意义（t分别为2．143，2．648，3．576，2．163；P均〈0．05）；胎心率比较差异无统计学意义（P〉0．05）。结论自控经皮电刺激耳神门穴具有明显的镇静、降压、抑制应激反应作用，可用于焦虑产妇剖宫产的术前准备。

Objective To study the feasibility of the therapy for the preoperative preparation maternal anxiety with patient-controlled transcutaneous electrical stimulation on auricular Shenmen point in cesarean section. Methods Totals of 60 primiparas （SAS score 〉 30 ）who underwent elective cesarean section were randomly divided into experiment group （n = 30 ）and control group （n =30）. Experiment group received patient- controlled sedation with transcutaneous electrical stimulation on auricular point after enter into the operating room （took Shenmen point frequency 1.5 Hz）. And the strength was controlled by themselves, continued stimulation for 30 minutes. While control group didn＇ t receive electrical stimulation. The indexes were observed such as HR, MAP, fetal heart rate when the women came to the operating room （T0 ）, after receiving 30 minutes stimulation （T1 ） , and the VAS score and the concentration of plasma angiotensin Ⅱ was compared. Results HR, MAP, VAS score and the concentration of plasma angiotensin Ⅱ of experiment group were （72 ± 9 ） bpm, （ 84 ± 11 ）mm Hg, （49.8 ± 20.8 ）, and （73.9 ± 21.8 ） ng/L, respectively, which was lower than that of the control group, and the difference was statistically significant （t = 2. 143,2. 648,3. 576,2. 163 ;P 〈 0.05）. There was no significant difference found in the fetal heart rate between two groups （ P 〉 0.05 ）. Conclusions Patient-controlled transcutaneous electrical stimulation on auricular Shenmen point can keep calm, decrease MAP and restrain the stress response of maternal in cesarean section for preoperative preparation.