耳穴磁珠贴压对初产妇硬膜外分娩镇痛中产间发热的影响

Effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia

目的:观察耳穴磁珠贴压干预对初产妇硬膜外分娩镇痛中产间发热的效果并探讨其可能机制。方法:将160例初产妇随机分为观察组(80例,脱落12例)和对照组(80例,脱落15例),对照组行硬膜外分娩镇痛;观察组在硬膜外分娩镇痛实施15 min后,取耳穴神门、内生殖器、内分泌、交感,行耳穴磁珠贴压,每隔15 min按揉1次,每次1 min,至第一产程结束。记录初产妇分娩镇痛前(Ta)、无痛分娩后2 h(Tb)、无痛分娩后4 h(Tc)和胎儿娩出后1 h(Td)时的鼓膜温度,比较两组产间发热率、Ta和Td时血清皮质醇和白介素6(IL-6)水平。观察两组行分娩镇痛前后视觉模拟量表(VAS)评分,分娩过程中自控硬膜外镇痛(PCEA)按压次数和舒芬太尼用量,记录两组分娩活跃期、第二产程、镇痛时间、缩宫素使用情况、阴道检查次数和剖宫产率。结果:观察组各时点鼓膜温度比较,差异均无统计学意义(P>0.05);对照组Tc和Td时鼓膜温度较Ta时升高(P<0.05);Tc和Td时,观察组鼓膜温度低于对照组(P<0.05)。Td时,两组血清皮质醇和IL-6水平高于Ta时(P<0.05),且观察组低于对照组(P<0.05)。观察组第二产程时间短于对照组(P<0.05),PCEA按压次数、舒芬太尼用量、产间发热发生率、缩宫素使用率及总量和阴道检查次数均低于对照组(P<0.05)。结论:耳穴磁珠贴压可降低麻醉药物的用量,减少硬膜外分娩镇痛对初产妇体温和产程进展的影响,并通过调控初产妇体内炎性反应水平,降低分娩镇痛中产间发热的发生率。

Objective To observe effect of magnetic beads auricular point sticking therapy on intrapartum fever in primipara with epidural labor analgesia and explore its possible mechanism. Methods A total of 160 primipara were randomly divided into an observation group(80 cases, 12 cases dropped off) and a control group(80 cases, 15 cases dropped off). The primipara in the control group received epidural labor analgesia. In the observation group, 15 min after epidural labor analgesia was performed, magnetic beads auricular point sticking therapy was given at shenmen(TF4), neishengzhiqi(TF2), neifenmi(CO18) and jiaogan(AH6a), pressing and kneading once every 15 min, 1 min each time, until the end of first stage of labor. The tympanic temperature on Ta(before labor analgesia), Tb(2 h after labor analgesia), Tc(4 h after labor analgesia) and Td(1 h after labor) was recorded, and the intrapartum fever incidence and level of serum cortisol and IL-6 between two groups were compared. The visual analogue scale(VAS) score before and after labor analgesia, the pressing times of patient controlled epidural analgesia(PCEA), and the dosage of sufentanil were observed. The active labor period, the second stage of labor, and the time of analgesia, the use of oxytocin, the number of vaginal examination and the rate of cesarean section were recorded in the two groups. Results There was no significant difference in tympanic temperature in the observation group at each time point(P>0.05), the tympanic temperature at Tc and Td in the control group was higher than that at Ta(P<0.05);the tympanic temperature at Tc and Td in the observation group was lower than that in the control group(P<0.05). The levels of serum cortisol and IL-6 at Td in the two groups were higher than those at Ta(P<0.05), and those in the observation group were lower than the control group(P<0.05). The second stage of labor in the observation group was shorter than that in the control group(P<0.05), and the pressing times of PCEA, the dosage of sufentanil,intrapartum fever incidence, usage rate and total amount of oxytocin and the number of vaginal examinations were all lower than those in the control group(P<0.05). Conclusion Magnetic beads auricular point sticking therapy can reduce the amount of anesthetics, decrease the effect of epidural analgesia on primipara’s body temperature regulation and labor progress,and lower the incidence of fever during labor analgesia by regulating the level of inflammatory response in the primipara.