剖宫产后TENS镇痛效果评价及其对产后应激的影响

Evaluation of the Analgesic Effect of TENS After Cesarean Section and Its Effect on Postpartum Stress

目的观察剖宫产术后经皮神经电刺激(TENS)镇痛的效果,及其对产后应激激素的影响。方法将58例初产妇随机双盲分为TENS组、病人自控镇痛(PCA)组、假TENS组3组。以术后1 h为镇痛前。在7个时间点(镇痛前、镇痛后5 min、镇痛后15 min、镇痛后30 min、镇痛后60 min、镇痛后24 h、镇痛后48 h)进行产后疼痛的VAS评分;分别于术前(剖宫产前24 h)、术后24 h、术后48 h 3个时点检测产后应激激素促肾上腺皮质激素(ACTH)、前列腺素(PG)。对比3组不同镇痛方式对产后应激激素的影响。结果 TENS组镇痛30 min后相比假TENS组VAS评分明显下降(P<0.05);镇痛后30 min开始,TENS组与PCA组间VAS无明显差异(P>0.05)。在术前24 h、术后24 h、术后48 h 3个时间点里,3组ACTH值组间均无差异(P>0.05)。术前24 h、术后24 h、术后48 h 3个时间里,3组前列腺素组间均无差异(P>0.05);但TENS组、PCA组两组在术后48 h前列腺素相比术后24 h有明显降低(P<0.05)。结论 TENS具有一定的镇痛作用,作用30 min以上可以达到和PCA等同的镇痛效果。TENS和PCA两种镇痛方式均可减低前列腺素水平。3种镇痛方式对血液中ACTH的影响无差异。

Objective To observe the analgesic effect of transcutaneous electrical nerve stimulation （TENS） after cesarean section, and its effect on postpartum stress-related hormones. Method By following a double-blinded design, 58 primiparas were randomized into TENS group, PCA group, and sham TENS group. The time of pre-analgesia was considered as 1 h after the operation. Visual Analogue Scale （VAS） was measured at 7 time points （pre-analgesia, 5 min after analgesia, 15 rain after analgesia, 30 min after analgesia, 60 min after analgesia, 24 h after analgesia, and 48 h after analgesia）. The postpartum stress-related hormones adrenocorticotrophic hormone （ACTH） and prostaglandin （PG） were detected at 3 time points： before the operation （24 h prior to cesarean section）, 24 h after the operation, and 48 h after the operation. The effects of the three analgesic methods on postpartum stress-related hormones were compared. Result The VAS score was significantly lower in TENS group than in sham TENS group 30 rain after analgesia （P〈 0.05）; there were no significant differences in VAS scores between TENS and PCA groups since 30 min after analgesia （P〉0.05）. At 24 h prior to the operation, and 24 h and 48 h after the operation, there were no significant between-group differences in ACTH （P〉0.05）. At 24 h prior to the operation, and 24 h and 48 h after the operation, there were no significant between-group differences in the level of PG （P〉 0.05）; but in TENS and PCA groups, the PG level at 48 h after the operation was significantly lower than that at 24 h after the operation （P〈0.05）. Conclusion TENS has certain analgesic effect, and it can reach equivalent analgesic effect compared with PCA when working over 30 min. Both TENS and PCA can down-regulate the level of PG. The three analgesia methods produce similar effects on blood ACTH.