经皮神经电刺激用于分娩镇痛的临床研究

Clinical Study on Transcutaneous Electrical Nerve Stimulation in Labor Analgesia

目的:观察经皮神经电刺激(TENS)合谷、三阴交、足三里穴用于分娩镇痛的临床效果并探讨其作用机制。方法:80例产妇随机分为2组,A组为TENS穴位组(临产后即予以TENS合谷、三阴交、足三里穴直至胎儿娩出);B组为对照组(不实施分娩镇痛)。记录2组产妇不同时点视觉模拟疼痛评分(VAS)、分娩结局及围生儿结局;于临产后(T_0)、宫口开全时(T_1)抽取静脉血检测2组产妇外周血β-内啡肽(β-EP)、皮质醇(Cor)及促肾上腺皮质激素(ACTH)的浓度。结果:A组产妇在产程潜伏期各时点VAS评分均低于B组,差异有统计学意义(P<0.05),但进入产程活跃期2组产妇VAS评分差异无统计学意义(P>0.05);A组产妇产程时间短于B组,差异有统计学意义(P<0.05);2组产妇产后出血量、新生儿Apgar评分差异无统计学意义(P>0.05)。与T_0时比较,2组产妇T_1时外周血β-EP、Cor及ACTH浓度均升高(P<0.05);A组产妇T_1时β-EP浓度高于B组(P<0.05),Cor及ACTH浓度低于B组(P<0.05)。结论:TENS合谷、三阴交、足三里穴可以很好地缓解潜伏期产痛,缩短产程,增加母婴安全性,其镇痛效果与β-EP含量明显增加及有效减少了产妇的应激反应有关,但活跃期镇痛不足是临床有待解决之处。

Objective: To observe the effects of electroacupuncture at Hegu, Sanyinjiao and Zusanli points in labor analgesia and to investigate the analgesic mechanism. Methods: 80 cases maternal were randomly divided into two groups,Group A: transcutaneous electrical nerve stimulation(TENS) group(Use TENS to Hegu, Sanyinjiao, Zusanli point in labor until the fetus was delivered); Group B: control group. Record VAS at different times, delivery outcome and perinatal outcome. Collect venous blood in both groups at the time of postpartum(T_0), uterus opens to the full extent(T_1) to test the concentration of β-EP,Cor and ACTH. Results: The VAS scores of group A were significantly lower than those of group B at each time points in incubation period of labor(P<0.05), but there was no significant difference in both groups after active phase of labor( P>0.05).The stage of labor in group A was shorter than that in group B(P <0.05). There was no significant difference in postpartum hemorrhage and Apgar score between two groups(P>0.05). Compared with T_0, the concentrations of β-EP, Cor and ACTH in peripheral blood of both groups were significantly increased at T_1(P<0.05). The concentration of β-EP at T_1 was significantly higher in group A than that in group B(P<0.05). Cor and ACTH concentrations were lower than those in group B(P<0.05).Conclusions: Electroacupuncture at Hegu, Sanyinjiao, Zusanli points can effectively relieve the pain in incubation period of labor, shorten the stage of labor and increase the safety of maternal-neonatal. Its analgesic effect was associated with the increase of neurotransmitter β-EP content and the effective reduction of maternal stress response. Further researches should be aimed to improve the analgesia effect in the active phase of labor.