小剂量芬氟合剂穴位注射用于分娩镇痛及对产妇应激激素水平的影响

Influence of acupoint injection with small dose of fentanyl-droperidol mixed liquor on labor analgesia and level of stress hormone in parturient

目的:观察小剂量芬太尼与氟哌利多混合液分时段穴位注射用于分娩镇痛的临床效果,并探讨其作用机制。方法:选择拟经阴道分娩的足月初产妇150例随机分为3组,每组50例。Ⅰ组予芬太尼与氟哌利多混合液分时段穴位注射,进入活跃期取肾俞穴,进入第2产程取次髎穴;Ⅱ组予芬太尼与氟哌利多混合液分时段皮下注射;Ⅲ组为对照组,与Ⅰ组、Ⅱ组相同时段皮下注射0.9%氯化钠溶液。分别观察各时段血压、视觉模拟量表(VAS)评分、去甲肾上腺素(NE)及肾上腺素(E)含量等。结果:活跃期及第2产程Ⅲ组产妇收缩压与注药前比较显著增高(P<0.05),且Ⅱ组、Ⅲ组显著高于Ⅰ组(P<0.05);活跃期及第2产程VAS评分Ⅰ组显著低于Ⅱ组、Ⅲ组(均P<0.01);注药后Ⅰ组NE、E含量显著低于注药前(P<0.05),且显著低于Ⅱ组、Ⅲ组(均P<0.05)。结论:小剂量芬氟合剂分时段穴位注射用于分娩镇痛临床效果确切,能显著降低产妇在分娩中的应激反应,其机制与降低产妇应激激素有关。

Objective To observe the clinical effect of acupoint injection with small dose of fentanyl-droperido mixed liquor at different time stages on labor analgesia, and explore its function mechanism. Methods One hun- dred and fifty cases of full-term primiparas who were intended to take vaginal delivery were randomly divided into 3 groups, 50 cases in each one. The acupoint injection with fentanyl-droperido mixed liquor at different time stages was applied in the group I , where Shenshu （BL 23） was selected in active phase and Ciliao （BL 32） was selected in the 2nd stage of labor. The subcutaneous injection with fentanyl-droperido mixed liquor was adopted in group Ⅱ The group Ⅲ, which was considered as a control group, was treated with subcutaneous injection of 0.9% NaC1 at the same time stage as group I and Ⅱ. The blood pressure, VAS score and level of norepinephrine and adrenaline were observed at different time stages. Results Compared before the injection, the blood pressure of group HI in the active phase and 2nd stage of labor was significantly increased （P〈0.05）, and that in groupⅡ andⅡwas obviously higher than that in the group I （P〈0. 05）. The VAS score of group I in the active phase and 2nd stage of labor was significantly lower than that in the group ⅡandⅢ （P（0.01）. After the injection, the level of NE and E was significantly decreased （P（0.05）, which was lower than that in the group ⅡandⅢ（P〈0.05）. Conclusion The aeupoint injection with small dose of fentanyl-droperido mixed liquor at different time stages has positive effect on labor analgesia, and it could significantly relieve stress reaction of parturient during the labor. Its mechanism could be related to the reduction of stress hormone in parturient.