新产程标准下经皮神经电刺激镇痛的应用观察

Clinical Application of Analgesia by Transcutaneous Electrical Nerve Stimulation under the New Partogram

目的评价新产程标准下经皮神经电刺激镇痛在足月产妇阴道试产中的应用效果。方法选择2017年1~8月于福永人民医院分娩的247例足月初产妇为研究对象,根据分娩镇痛的情况,分为经皮神经电刺激镇痛组(TENS组,n=86),连续硬膜外镇痛组(CEA组,n=48)及无镇痛的为空白对照组(n=113)。观察并记录三组产妇镇痛前即刻,镇痛起效时,镇痛60 min、120 min及180 min后视觉模拟评分量表(VAS)评分、第一、二产程时间、阴道分娩率、非指征转剖宫产率、催产素及器械助产使用情况,新生儿出生1 min及5 min时Apgar评分以及产妇对分娩镇痛效果满意度评价等数据。结果镇痛效果上,TENS组及CEA组镇痛起效后各时间点VAS评分、疼痛程度组成均优于对照组(P均<0.001),CEA组优于TENS组(P<0.05)。TENS组与对照组产程时间对比没有统计学差异,CEA组则第一、二产程时间均长于其他两组(P均<0.05)。TENS组及CEA组阴道分娩率、非指征转剖宫产率均低于对照组,但差异没有统计学差异(P均>0.05)。三组在催产素及器械助产使用情况、新生儿出生1 min及5 min Apgar评分对比没有统计学差异。结论采用经皮神经电刺激分娩镇痛效果较好,可降低非指征转剖宫产率,对母婴无不利影响,镇痛效果虽不及连续硬膜外镇痛,但其无创、易于操作、费用低廉等特点更易为产妇及家属接受,亦更易于在基层医疗机构开展。

Objective To evaluate the effect of analgesia by transcutaneous electrical nerve stimulation for parturient on full-term vaginal delivery under the new partogram. Methods A total of 247 full-term primiparous parturient who delivered at Fuyong People＇s Hospital from January to August in 2017 were divided into three groups according to labor analgesia methods： Transcutaneous electrical nerve stimulation（ TENS group,n = 86）,Epidural analgesia group（ CEA group,n =48） and no analgesia group（ n = 113）. The visual analogue scale（ VAS）,the first and second stage of labor,the vaginal delivery rate,CDMR rate,the Oxytocin usage rate,the equipment midwifery rate,the Apgar score at 1 min and 5 min after birth and the satisfaction score of maternal were collected at 60 min,120 min,and 180 min after parturition,and respectively analyzed. Results The VAS scores and pain scores of TENS group and CEA group were better than those of control group（ all P〈0. 001）,and CEA group was better than TENS group（ P〈0. 05）. There was no significant difference in labor time between TENS group and control group,while the time of first and second labor in CEA group was longer than that of the other two groups（ all P〈0. 05）. The vaginal delivery rate and cesarean section rate in TENS group and CEA group were lower than those in control group,but there was no significant difference（ P〈0. 05）. There was no significant difference in Apgar scores,usage of oxytocin and equipment midwifery among the three groups. Conclusion Using transcutaneous electrical nerve stimulation on labor analgesia can reduce the CDMR rate,and had no adverse effects on both mother and child. Though not good as the continuous epidural analgesia,it＇s noninvasive,easy to operate,and low cost makes it easier for parturient and family members to accept. Additionally it＇s easier to carry out in the primary health care institutions.