经皮穴位电刺激对剖宫产产妇蛛网膜下腔阻滞后低血压的影响

Effect of transcutaneous electroacupuncture on hypotension after subarachnoid block in parturients undergoing cesarean section

目的观察经皮穴位电刺激对剖宫产产妇蛛网膜下腔阻滞后低血压的影响。方法选择2021年1—4月择期行剖宫产的产妇65例,年龄18~40岁,BMI 19~35 kg/m^(2),ASAⅠ或Ⅱ级,孕期37~41周。将产妇随机分为两组:电刺激组(n=34)和对照组(n=31)。电刺激组在内关穴进行电刺激,频率为50 Hz,电刺激30 min。对照组仅于内关穴连接电极,不予电刺激。记录蛛网膜下腔推注局麻药结束后即刻、1、3、6、9、12 min、胎儿娩出时的HR、SBP和DBP。记录蛛网膜下腔推注局麻药结束后至胎儿娩出期间产妇心动过缓和低血压发生情况。记录新生儿出生后1、5 min Apgar评分。记录镇痛泵使用时间和有效按压次数。记录产妇头晕、胸闷、气短、恶心、呕吐和寒战等不良反应发生情况。结果电刺激组心动过缓、低血压发生率明显低于对照组(P<0.05)。蛛网膜下腔推注局麻药结束后即刻、1、3、6、9、12 min、胎儿娩出时两组HR、SBP、DBP差异均无统计学意义。新生儿出生后1、5 min Apgar评分均为10分。两组产妇头晕、胸闷、气短、恶心、呕吐和寒战的发生率差异均无统计学意义。结论经皮穴位电刺激内关穴降低了剖宫产产妇蛛网膜下腔阻滞后心动过缓、低血压的发生率,并减少其血流动力学波动。

Objective To observe the effect of transcutaneous electrical acupoint stimulation on hypotension after subarachnoid block in parturients undergoing cesarean section.Methods Sixty-five parturients undergoing elective cesarean section from January 2021 to April 2021,aged 18-40 years,BMI 19-35 kg/m^(2),ASA physical statusⅠorⅡ,gestational age 37-41 weeks,were randomly divided into two groups:electrical stimulation group(n=34)and control group(n=31).In electrical stimulation group,electrical stimulation was performed at Neiguan acupoint with a frequency of 50 Hz for 30 minutes.In control group,the electrodes were only connected to Neiguan acupoint but without electrical stimulation.HR,SBP and DBP were recorded at the time of subarachnoid injection,1,3,6,9,and 12 minutes after subarachnoid injection of local anesthetic block,and at the time of fetal delivery.The incidence of bradycardia and hypotension were recorded from the end of subarachnoid injection with local anesthetic block to fetal delivery.Apgar scores of neonatus 1 and 5 minutes after birth were recorded.The time of using analgesic pump and the number of effective analgesic pump compressions were recorded.Adverse reactions such as dizziness,chest tightness,shortness of breath,nausea,vomiting,shivering were recorded.Results Compared with control group,the incidence of bradycardia and hypotension in electrical stimulation group was significantly lower(P<0.05).There were no significant differences in HR,SBP and DBP at the time of subarachnoid injection,1,3,6,9,and 12 minutes after subarachnoid injection of local anesthetic block,and at the time of fetal delivery between the two groups.The Apgar score 1 and 5 minutes after birth of all newborns was 10.There were no significant differences in the incidence of nausea,vomiting,chest tightness,shortness of breath,palpitation,shivering and dizziness between the two groups.Conclusion Transcutaneous electrical acupoint stimulation of Neiguan point reduced the incidence of bradycardia,hypotension and hemodynamic fluctuation after subarachnoid block in parturients undergoing cesarean section.