经皮穴位电刺激联合硬膜外分娩镇痛对产后抑郁症的影响

Effect of transcutaneous electrical acupoint stimulation combined with epidural labor analgesia on postpartum depression

目的:观察经皮穴位电刺激联合硬膜外分娩镇痛对产后抑郁症的影响并探讨其作用机制。方法:选取2018年5月至2018年11月在晋中市妇幼保健院收治的足月单胎头位妊娠初产妇120例,将有分娩镇痛要求的产妇随机分为硬膜外组和联合组,将同期无分娩镇痛要求的产妇设为对照组,每组40例。对照组不实施分娩镇痛,按自然分娩常规程序处理;硬膜外组采用硬膜外分娩镇痛;联合组采用经皮穴位电刺激联合硬膜外分娩镇痛,经皮穴位电刺激选取双侧合谷、三阴交和足三里进行干预,疏密波,2 Hz/100 Hz,电流强度从15 mA逐渐加强,每间隔2 h进行1次治疗,每次20 min。观察并记录3组产妇宫口开3、6、8、10 cm时疼痛视觉模拟量尺(VAS)评分;用高效液相色谱法检测镇痛前即刻、第三产程末及产后42 d产妇血浆中谷氨酸(Glu)的浓度;并于产后42 d进行定爱丁堡产后抑郁量表(EPDS)评分。结果:与对照组比较,硬膜外组和联合组各时点VAS评分、产后42 d EPDS评分和产后抑郁症发生率明显降低(P<0.05),且联合组比硬膜外组降低更明显(P<0.05)。镇痛前即刻,3组产妇血浆中Glu含量差异无统计学意义(P>0.05)。与对照组比较,在第三产程末及产后42 d,硬膜外组、联合组产妇血浆中Glu水平明显降低(P<0.05),且联合组比硬膜外组降低更明显(P<0.05)。结论:经皮穴位电刺激联合硬膜外分娩镇痛可以降低产后抑郁症的发生率,其机制可能与降低血浆Glu水平及缓解分娩疼痛有关。

Objective To observe the effect of transcutaneous electrical acupoint stimulation(TEAS)combined with epidural analgesia on postpartum depression and to explore its underlying mechanism. Methods One hundred and twenty cases of full-term primiparous women with singleton pregnancy were selected from May 2018 to November 2018 in Jinzhong Maternal and Child Health Hospital. The parturients with labor analgesia requirement were randomly divided into the epidural group and the combination group, and the parturients without labor analgesia requirement were used as the control group, with 40 cases in each group. Patients in the control group did not receive labor analgesia and were treated according to the routine procedures of natural delivery;patients in the epidural group received epidural labor analgesia;patients in the combination group received TEAS at bilateral Hegu(LI4), Sanyinjiao(SP6) and Zusanli(ST36)(2 Hz/100 Hz, the current intensity is gradually increased from 15 mA, and the treatment was performed every 2 h, 20 min each time) combined with epidural labor analgesia. The visual analogue scale(VAS) scores were recorded when the uterine orifice opened to 3, 6, 8, 10 cm. Plasma glutamate was measured using high-performance liquid chromatography before analgesia, at the end of the third stage of labor and 42 days after delivery, and Edinburgh postnatal depression scale(EPDS) score was measured at 42 days after delivery.Results In comparison with the control group, the VAS score, EPDS score and the incidence of postpartum depression of the epidural group and the combination group were significantly lower(P<0.05), and the combination group had significant decrease than those in epidural group(P<0.05). Immediately before analgesia, there was no statistically significant difference in glutamate levels among the 3 groups(P>0.05). Compared with the control group, at the end of the third stage of labor and 42 days postpartum, the glutamate levels of the epidural group and the combination group were significantly reduced(P<0.05), and the combination group decreased more significantly than the epidural group(P<0.05). Conclusion TEAS combined with epidural analgesia can reduce the incidence of postpartum depression, possibly by down-regulating plasma glutamate level and relieving of labor pain.