经皮穴位电刺激在分娩镇痛中的作用

Effect of transcutaneous electrical acupoint stimulation on labor analgesia

目的:观察经皮穴位电刺激(TEAS)对分娩疼痛的影响。方法:将151例经阴道分娩的初产妇随机分为TEAS组(76例)和硬膜外组(75例)。硬膜外组采用硬膜外阻滞麻醉镇痛;TEAS组采用经皮穴位电刺激镇痛,穴取合谷、内关、夹脊穴(T10~L1)、次髎,采用疏密波(2 Hz/100 Hz),电流强度为15~50 m A。镇痛时间均为宫口开至3 cm到宫口全开。观察两组患者镇痛前即刻,镇痛后30、60、120 min视觉模拟量表(VAS)评分变化;记录各产程时长、产程中缩宫素使用率、产妇不良反应发生率及产后出血量;评估新生儿1分钟、5分钟Apgar评分。结果:两组产妇镇痛后VAS评分均表现为逐渐下降趋势(P<0.01),但TEAS组下降幅度小于硬膜外组(P<0.01);TEAS组第一产程活跃期和第二产程时长均短于硬膜外组(P<0.01,P<0.05),两组第三产程时长比较差异无统计学意义(P>0.05);TEAS组产程中缩宫素使用率及不良反应发生率分别为9.2%(7/76)和2.6%(2/76),均明显低于硬膜外组的34.7%(26/75)和18.7%(14/75)(P<0.01);两组产后出血量及新生儿1分钟、5分钟Apgar评分比较差异无统计学意义(P>0.05)。结论:TEAS镇痛效果虽不如硬膜外阻滞,但可减轻产痛至产妇能耐受程度,并能缩短第一产程活跃期及第二产程时长、减少缩宫素使用,且不良反应小。

Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS) on labor pain.Methods A total of 151 primiparas who were vaginal delivery were randomized into a TEAS group(76 cases) and a peridural group(75 cases). In the peridural group, peridural blockage was applied to analgesia. In the TEAS group, TEAS was applied at Hegu(LI 4),Neiguan(PC 6), Jiaji T10~L1(EX-B 2) and Ciliao(BL 32), disperse-dense wave(2 Hz/100 Hz), 15-50 m A in current intensity. The analgesic time was from 3 cm to completely opening of cervix. The visual analogue scale(VAS) scores were observed before analgesia, after 30, 60, 120 min of analgesia in the two groups. The time of different stages of labor, usage rate of oxytocin, incidence rate of adverse reaction and amount of postpartum hemorrhage were recorded. The newborn’s 1 and 5 min Apgar scores were evaluated. Results The VAS scores showed a downward trend in the two groups after analgesia(P<0.01), and the change of the TEAS group was less than the peridural group(P<0.01). The active phase on the first stage and second stage of labor in the TEAS group were shorter than the peridural group(P<0.01, P<0.05), there was no significant difference in the time of third stage of labor between the two groups(P>0.05). The usage rate of oxytocin and incidence rate of adverse reaction in the TEAS group were 9.2%(7/76) and 2.6%(2/76), which were lower than 34.7%(26/75) and 18.7%(14/75) in the peridural group(P<0.01). There was no significant difference in the amount of postpartum hemorrhage and newborn’s 1 and 5 min Apgar scores between the two groups(P>0.05). Conclusion The analgesic effect of TEAS is inferior to peridural blockage, but TEAS could relieve labor pain to the tolerance, shorten the time of active phase on the first stage and second stage of labor and reduce the use of oxytocin, has mild adverse reaction.