右美托咪定对穴位电刺激产妇分娩镇痛效果的影响

Effect of Dexmedetomidine on Labor Analgesia in the Matermal with Transcutaneous Point Electric Stimulation

目的:探讨右美托咪定对穴位电刺激产妇分娩镇痛效果的影响。方法:100例产妇随机分为右美托咪定联合穴位刺激组(A组)和穴位刺激组(B组)。A组临产后静脉输注右美托咪定,同时经皮神经电刺激合谷、三阴交和足三里穴直至胎儿娩出;B组仅经皮神经电刺激合谷、三阴交和足三里穴。记录两组产妇不同时点VAS和Ramsay评分、产程时间、产后出血量及新生儿Apgar评分,并于临产后(T_0)和宫口开全时(T_1)取静脉血测β-内啡肽(β-EP)、皮质醇(Cor)及促肾上腺素皮质激素(ACTH)浓度。结果:A组各时点VAS评分均明显低于B组,Ramsay评分明显高于B组,差异均有统计学意义(P<0.01);A组第二产程时间短于B组,差异有统计学意义(P<0.01);两组产妇T_0时血β-EP、Cor及ACTH浓度比较差异无统计学意义(P>0.05)。与T_0时比较,两组产妇T_1时血β-EP、Cor及ACTH浓度均明显升高,A组产妇T_1时β-EP浓度高于B组,Cor和ACTH浓度低于B组,差异均有统计学意义(P<0.01)。结论:右美托咪定可提高穴位电刺激产妇的分娩镇痛效果,缩短第二产程,其机制可能与β-EP含量增加及减轻应激反应有关。

Objective： To investigate the effect of Dexmedetomidine on labor analgesia for the matermal with transcutaneous point electric stimulation, Method： A totai of 100 cases were randomly divided into two groups： Dexmedetomidine combined with TENS（Group A） and TENS only（Group B）.Intravenous Dexmedetomidine combined with TENS to Hegn, Sanyinjiao, Zusanli points were given in Group A until the fetus was delivered, and TENS to Hegu, Sanyinjiao, Zusanli points only in Group B. VAS/Ramsay scores at different time, Labor time, Volume of postpartum hemorrhage and Apgar score were recorded.Blood samples were taken from both groups at the time of labor@0） and complete cervical dilationu（Tl） to test the concentrations of 13 -endorphin, cortisol and ACTH. Result ： The VAS scores of group A at each time were significantly lower than those of group B and the Ramsay scores of group A were significantly higher than those of group B（P〈0.01）.The second stage of labor in group A was shorter than that in group B （P〈0.01）.There was no significant difference in the volume of postpartum hemorrhage and Apgar score between two groups（P〉 0.05）.Compared with To, the concentrations of blood 13 -endorphin, cortisol and ACTH in both groups significantly increased at T^（P〈0.01）.The concentration of 13 -endorphin at T~ was significantly higher in group A than that in group B （P 〈0.01）. Cortisol and ACTH concentrations were lower than those in group B （P〈0.01）.Conelusion： Dexmedetomidine can improve the effect of labor pain on maternals with TENS and shorten the second stage of labor.The mechanism may be associated with the increase of 13 -EP levels and the reduction of stress responses.