潜伏期虚拟现实技术用于分娩镇痛的效果

Effects of virtual reality at the latent stage of labor for labor analgesia

目的探讨分娩潜伏期虚拟现实(virtual reality,VR)技术联合硬膜外阻滞对初产妇围生期镇痛效果、焦虑抑郁情绪及分娩应激的影响.方法将130例初产妇按随机数字表法分为两组(每组65例):潜伏期VR联合活跃期硬膜外阻滞组(A组)和单一活跃期硬膜外阻滞组(B组).A组潜伏期(规律宫缩至宫口开至1 cm)行VR干预30 min,B组潜伏期不进行VR干预,两组产妇均于宫口开至3 cm时行硬膜外阻滞.记录两组产妇宫口开至1 cm时(T_(0))、宫口开至1 cm后30 min(T_(1))、宫口开至1 cm后1 h(T_(2))及硬膜外给药前(T_(3))、给药后10 min(T_(4))、给药后30 min(T_(5))、给药后1 h(T_(6))、给药后2 h(T_(7))、宫口开全(T_(8))时的数字分级评分法(Numerical Rating Scale,NRS)疼痛评分,T_(0)、T_(1)、T_(5)、产后2 h(T_(9))时状态-特质焦虑量表(State-Trait Anxiety In-ventory,STAI)评分[包括状态焦虑量表(State Anxiety Inventory,S-AI)评分和特质焦虑量表(Trait Anxiety Inventory,T-AI)评分],T_(0)、T_(1)、T_(5)、产后3 d(T_(10))时的爱丁堡产后抑郁量表(Edinburgh Postnatal Depression Scale,EPDS)评分;ELISA法检测T_(0)、T_(1)、T_(9)时两组产妇唾液皮质醇(cortisol,COR)、IL-6水平及脐动脉血COR、IL-6水平;记录两组产妇产程时间、镇痛药物用量、患者自控镇痛(patient controlled analgesia,PCA)次数及产后满意度等.结果与B组比较:A组T_(1)、T_(2)时NRS疼痛评分,T_(1)、T_(5)时S-AI评分,T_(1)时T-AI评分,T_(1)、T_(10)时EPDS评分,T_(1)时唾液COR及IL-6水平降低(P<0.05),产后满意率升高(P<0.05).与T_(0)比较:A组T_(1)~T_(8)时NRS疼痛评分,T_(1)、T_(5)、T_(9)时S-AI评分及T-AI评分,T_(10)时EPDS评分,T_(1)、T_(9)时唾液COR、IL-6水平降低(P<0.05);B组T_(3)~T_(8)时NRS疼痛评分,T_(5)、T_(9)时S-AI评分及T-AI评分,T_(9)时唾液COR、IL-6水平降低(P<0.05).两组产妇脐动脉血COR及IL-6水平、产程时间、镇痛药物用量、PCA次数差异无统计学意义(P>0.05).结论分娩潜伏期应用VR技术联合硬膜外阻滞行分娩镇痛可有效缓解初产妇围生期疼痛、焦虑抑郁情绪及分娩应激,提高产妇产后满意度.

Objective To explore the effects of virtual realit(VR)at the latent stage combined with epidural block on the analgesic effect,anxiety,depression and labor stress for primiparas during the perinatal period.MethodsAccording to the random number table method,130 primiparas were divided into two groups(n=65):group A which underwent VR at the latent phase combined with epidural block at the active phase,and group B which underwent epidural block at the active phase.For group A,VR started when the cervix was 1 cm dilated and intervened for 30 min,followed by epidural analgesia when the cervix was 3 cm dilated.For group B,epidural analgesia was performed when the cervix was dilated to 3 cm.Their Numerical Rating Scale(NRS)scores were measured when the cervix was dilated to 1 cm(T_(0)),30 min after 1 cm cervical dilatation(T_(1)),1h after 1 cm cervical dilatation(T_(2)),before epidural analgesia(T_(3)),10 min(T_(4)),30 min(T_(5)),1 h(T_(6)),and 2 h(T_(7))after analgesia,and at full dilatation(T_(8)).Their State-Trait Anxiety Inventory(STAI)scores[including State Anxiety Inventory(S-Al)scores and Trait Anxiety Inventory(T-AI)scores]were recorded at T_(0),T_(1),T_(5),and 2 h after delivery(T_(9)),Their Edinburgh Postnatal Depression Scale(EPDS)scores at T_(0),T_(1),T_(5),and 3 days after delivery(T_(10))were recorded.The levels of cortisol(COR),interleukin-6(IL-6)in the saliva and umbilical artery blood at T_(0),T_(1),and T_(9),were detected by enzyme-linked immunosorbent assay(ELISA).The duration of labor,consumption of anesthetics,the times of patient con-trolled analgesia(PCA)pressing and postpartum satisfaction were recorded.Results Compared with group B:group A presented remarkable decreases in NRS scores at T_(1),and T_(2),S-AI scores at T_(1),and T_(5),T-AI scores at T_(1),EPDS scores at T_(1),and c,the levels of salivary COR and IL-6 at T_(1),(P<0.05),and increases in postpartum satisfaction(P<0.05).Compared with those at T_(0):group A presented significant decreases in NRS scores at T_(1),-T_(8),S-AI scores and T-AI scores at T_(1),T_(5),and T_(9),EPDS scores at T_(10),and the levels of salivary COR and IL-6 at T_(1),and T_(9),(P<0.05);while group B showed significant decreases in NRS scores at T_(3)-T_(8),S-AI scores and T-AI scores at T_(5) and T_(9) and the levels of salivary COR and IL-6 at T_(9)(P<0.05).There was no statistical diference in the levels of COR and IL-6 in the umbilical artery blood,the duration of labor,the consumption of anesthetics and the times of PCA pressing between two groups(P>0.05).Conclusions The application of VR at the latent phase combined with epidural block for labor analgesia can ffectively lleviate pain,anxiety,depression and labor stress during the perinatal period,so as to improve postpartum satisfaction.