潜伏期电针镇痛在硬膜外分娩镇痛中的作用与安全性研究

Effect and safety of electroacupuncture analgesia at the latent stage of labor on the epidural analgesia

目的:探讨潜伏期电针对硬膜外分娩镇痛疗效、分娩结局及新生儿评分的影响,为临床分娩镇痛提供参考。方法:经阴道分娩初产妇104例按随机数字表法分为电针组37例、假电针组36例、硬膜外阻滞组31例。电针组于宫口开至1 cm时用韩氏穴位神经刺激仪刺激双侧合谷、三阴交穴行电针镇痛直至活跃期开始(宫口3 cm);假电针组同电针组,但为假针刺激;硬膜外阻滞组无电针干预。各组均于宫口3 cm时行硬膜外阻滞及自控硬膜外镇痛。比较各组患者不同时相疼痛情况视觉模拟量尺(VAS)评分及自控镇痛泵舒芬太尼和罗哌卡因用量;于电针刺激1 h(T1)、电针刺激2 h(T2)、硬膜外阻滞即刻(T3)、宫口开全时(T6)抽取产妇静脉血检测β-内啡肽(β-EP)含量,记录缩宫素使用时间、出血量、新生儿状态等。结果:各组产妇电针刺激即刻(T0)VAS差异无统计学意义(P>0.05),但电针组T1-T6各时间点与假电针组、硬膜外阻滞组相比VAS明显降低(P<0.05)。各组产妇缩宫素使用时间差异无统计学意义(P>0.05)。假电针组和硬膜外阻滞组产时及产后24 h出血量多于电针组(P<0.05)。各组产妇T3、T6时血清β-EP含量较T1、T2时明显升高(P<0.05),电针组T1-T3、T6时β-EP含量均高于假电针组和硬膜外阻滞组(P<0.05)。电针组罗哌卡因、舒芬太尼用量均显著少于假电针组和硬膜外阻滞组(P<0.05)。各组新生儿羊水浑浊率、Apgar评分差异无统计学意义(P>0.05)。结论:潜伏期电针分娩镇痛可有效减轻产妇分娩疼痛,可增加产妇血清β-EP含量,并可加强硬膜外阻滞分娩镇痛疗效,减少硬膜外分娩镇痛药物用量,减少产时产后出血,对新生儿无不良影响,潜伏期电针镇痛与硬膜外阻滞联合可用于全产程镇痛。

Objective To investigate the effect of electroacupuncture(EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia. Methods According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group(37 cases), a sham-EA group(36 cases) and an epidural block group(31 cases). In the EA group, when the cervix opened up by 1 cm, Han’s acupoint nerve stimulation apparatus was attached to bilateral Hegu(LI4) and bilateral Sanyinjiao(SP6) to achieve EA analgesia till the active stage(the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale(VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation(T1), 2 h of EA stimulation(T2), at the moment of epidural block(T3) and the complete open of the cervix(T6), the venous blood sample was collected to determine the concentration of beta-endorphin(beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded. Results There was no statistical difference in immediate of EA stimulation(T0) among the groups in VAS score(P>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately(P<0.05). There was no statistical difference in the use time of oxytocin among the three groups(P>0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group(P<0.05). In each group, the concentration of beta-EP in T3 and T6 was increased obviously as compared with that in T1 and T2 respectively(P<0.05). In the EA group, the concentration of beta-EP in T1 to T3 and in T6 was higher than that in sham-EA group and the epidural block group respectively(P<0.05). The dosage of Ropivacaine and Sufentanil in the EA group was less than that in either the sham-EA group or the epidural block group(P<0.05). There was no significant difference in amniotic fluid turbidity rate and Apgar score among the three groups(P>0.05). Conclusion Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.