经皮神经电刺激联合分娩球对产程、产痛及镇痛药物应用影响

Effect of Transcutaneous Electrical Nerve Simulation plus Birthing Ball on Labor Stage, Labor Pain and Analgesic Use

目的观察经皮神经电刺激(TENS)联合分娩球对产程、产痛及镇痛药物应用的影响。方法 186例产妇随机分为对照组(93例)和观察组(93例),对照组给予分娩球辅助分娩,观察组在对照组的基础上联合TENS辅助分娩。观察两组产程时间、镇痛药物使用及不同时间点视觉模拟量表(VAS)评分变化,比较两组临产时与宫口全开时血清强啡肽(DYN)、皮质醇(Cor)、去甲肾上腺素(NE)和肾上腺素(E)水平变化。结果观察组第一、二、三产程均短于对照组(t=-2.326,-2.143,-3.055;P=0.021,0.033,0.003),观察组镇痛药物使用率显著低于对照组(52.7%vs 75.3%;χ~2=10.288,P=0.001),开始使用镇痛药物时间显著迟于对照组(t=5.957,P=0.000),使用剂量显著低于对照组(t=-3.221,P=0.002)。两组临产时VAS评分比较,差异无统计学意义(t=-1.830,P=0.069)观察组潜伏期VAS评分显著低于对照组(t=-3.315,-5.611;P=0.001,0.000);两组活跃期VAS评分比较,差异无统计学意义(t=1.789,-1.900,-0.754,-0.444;P=0.075,0.059,0.452,0.658)。临产时,两组血清DYN、Cor、NE及E比较,差异无统计学意义(t=1.454,-0.423,-0.149,-0.182;P=0.148,0.673,0.881,0.855);宫口全开时,观察组血清DYN水平显著高于对照组(t=2.748,P=0.007),Cor、NE及E水平低于对照组(t=-2.455,-2.517,-2.728;P=0.015,0.013,0.007)。观察组产妇产后并发症总发生率显著低于对照组(8.6%vs 22.6%;χ~2=6.904,P=0.008)。结论 TENS联合分娩球可以有效缩短产程时间,减轻分娩疼痛,减少以及延迟镇痛药物的使用,且安全性高。

Objective To investigate the effect of transcutaneous electrical nerve stimulation(TENS) plus a birthing ball on labor stage,labor pain and analgesic use.Method One hundred and eighty-sixty parturients were randomized to a control group(93 cases) and an observation group(93 cases).The control group gave birth with the help of a birthing ball and the observation group,with the help of TENS in addition.Labor duration and analgesic use were observed and the visual analogue scale(VAS) score was recorded at different time points in the two groups.Serum dynorphin(DYN),cortisol(Cor),norepinephrine(NE) and epinephrine(E) levels were compared between the two groups near the time of labor and at full cervical dilatation.Result The first,second and third stages of labor were shorter in the observation group than in the control group(t=-2.326,-2.143,-3.055;P=0.021,0.033,0.003).Analgesic use rate was significantly lower(52.7% vs 75.3%;χ~2=10.288,P=0.001),the time to start using analgesics was significantly later(t=5.957,P=0.000) and analgesic dosage was lower(t=-3.221,P=0.002) in the observation group than in the control group.There was no statistically significant difference in the VAS score between the two groups near the time of labor(t=-1.830,P=0.069).The VAS score was significantly lower during the latent stage in the observation group than in the control group(t=-3.315,-5.611;P=0.001,0.000).There was no statistically significant difference in the VAS score between the two groups during the active stage(t=1.789,-1.900,-0.754,-0.444;P=0.015,0.059,0.452,0.658).There were no statistically significant differences in serum DYN,Cor,NE and E levels between the two groups near the time of labor(t=1.454,-0.423,-0.149,-0.182;P=0.148,0.673,0.881,0.855).Serum DYN levels were significantly higher(t=2.748,P=0.007) and Cor,NE and E levels were significantly lower(t=-2.455,-2.517,-2.728;P=0.015,0.013,0.007) at full cervical dilatation in the observation group than in the control group.The overall incidence of postpartum complications was significantly lower in the observation group than in the control group(8.6% vs 22.6%;χ~2=6.904,P=0.008).Conclusion TENS plus a birthing ball can effectively shorten labor duration,alleviate labor pain and reduce or delay analgesic use with high safety.