针刺在分娩镇痛中应用与安全性临床观察

Application and Security Observation of Acupuncture in Labor Analgesia

目的观察足月自然分娩过程中,针刺穴位与硬膜外麻醉的疗效与安全性。方法纳入符合自然分娩的研究对象199例,随机分为4组。针刺组采用针刺穴位方法;硬膜外组实施硬膜外麻醉;复合镇痛组采用针刺穴位联合硬膜外麻醉;对照组不采用任何镇痛干预。主要观察指标根据疼痛视觉模拟评分(VAS)记录比较干预全程(宫口3 cm即0 min、30 min、60 min和宫口全开时)产妇分娩疼痛,同时记录第一产程活跃期时间、宫口扩张速度、第二产程时间、剖宫产率、器械助产率、Apgar评分以及产后出血量(2 h)。全程监测第一产程中血?-内啡肽和5-HT水平变化。结果 VAS评分显示,较之对照组,其他三组皆有不同程度下降,其中硬膜外组和复合镇痛组下降程度相似,而针刺组下降幅度稍逊色;比较产程相关指标,针刺组产妇宫口扩张速度快于对照组(P<0.05),第二产程时间针刺组与对照组无明显差异(P>0.05);综合产后出血,新生儿Apgar评分,4组没有显著差异(P>0.05),但针刺组跟硬膜外组比较,未有使用助产催产;第一产程中产妇血?-内啡肽,针刺组和复合镇痛组观察到不同程度上升(P<0.05),而硬膜外组与对照组则没有观察到显著变化(P>0.05)。结论针刺镇痛可减轻分娩痛,缩短产程,同时不影响第二产程及各项产妇胎儿安全指标。

Objective To observe the therapeutic efficacy and safety of acupuncture and epidural anesthesia during full-term labor. Method A total of 199 eligible subjects experiencing natural labor were randomized into four groups. The acupuncture group was intervened by acupuncture at acupoints; the epidural group was given epidural anesthesia; the combined analgesia group was given acupuncture at acupoints plus epidural anesthesia; the control group was not given any interventions for analgesia. The Visual Analogue Scale（VAS） was adopted to record and compare labor pain（cervix dilation 3 cm at 0 min, 30 min, and 60 min, and at full cervix dilation）; meanwhile, the active period of the first stage of labor, cervix dilation speed, the second stage of labor, Caesarean section（C-section） rate, instrumental delivery rate, Apgar score, and post-labor bleeding amount（2 h） were also recorded. The contents of blood β-endorphin（β-EP） and 5-hydroxytryptamine（5-HT） were monitored during the first stage of labor. Result Compared with the control group, the VAS scores dropped in the other three groups, and the decreases were similar in the epidural group and combined analgesia group, while the decrease in the acupuncture group was the least significant. Regarding the labor-related indexes, the cervix dilation speed was higher in the acupuncture group than in the control group（P〈0.05）, while there was no significant difference between the acupuncture group and control group in comparing the duration of the second labor stage（P〈0.05）. There were no significant between-group differences in comparing the post-labor bleeding amount and Apgar score of the new-born babies（P〉0.05）, but compared with the epidural group, there was no use of assisted delivery. The content of blood β-EP during the first stage of labor increased in the acupuncture group and combined analgesic group（P〈0.05）, but there were no significant changes in the epidural group and control group（P〉0.05）. Conclusion Acupuncture analgesia can reduce labor pain and shorten labor duration without affecting the second stage of labor and security-related indexes.