经皮穴位电刺激对剖宫产患者术后舒适度及泌乳功能的影响

Effect of transcutaneous electrical acupoint stimulation on patient comfort and lactation after cesarean section

目的探讨经皮穴位电刺激(TEAS)对产妇剖宫产术后舒适度及泌乳功能的影响。方法本研究选取了2020年11月至2021年7月在贵州省人民医院行择期剖宫产手术的产妇125例,最终选择符合纳入标准的产妇共90例,年龄18~35岁,单胎足月妊娠,孕周37~41周,美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,体质量50~90 kg。采用随机数字表法分为3组:TEAS组、硬膜外自控镇痛(PCEA)组、对照组,每组30例。采用术后视觉模拟量表(VAS)记录产妇术后1~3 d的疼痛情况及术后镇痛补救发生率。记录产妇术后泌乳始动时间,评估术后1~3 d泌乳充足率,检测术前及术后1~3 d的血清泌乳素和多巴胺的含量。记录产妇术后1~3 d恶心呕吐发生率及首次肛门排气时间,采用QoR-40量表对患者术后1~3 d恢复质量进行评分。组间比较采用单因素方差分析、Kruskal-Wallis检验、χ^(2)检验。结果TEAS组、PCEA组产妇术后VAS评分及术后恶心呕吐发生率均显著低于对照组(均P<0.05),并且术后QoR40评分均显著高于对照组(均P<0.05)。TEAS组与PCEA组QoR40评分对比,差异无统计学意义(P>0.05)。TEAS组产妇泌乳始动时间为(23.63±1.94)h、泌乳充足率为93.3%(28/30),PCEA组分别为(35.77±3.09)h、83.3%(25/30),对照组分别为(41.70±2.52)h、66.7%(20/30),TEAS组产妇泌乳始动时间、泌乳充足率均优于PCEA组、对照组(均P<0.05);TEAS组产妇产后血清泌乳素含量均优于PCEA组、对照组(均P<0.05);TEAS组产妇首次肛门排气时间及血清中多巴胺含量明显低于PCEA组及对照组(均P<0.05)。结论TEAS有利于提高剖宫产产妇术后舒适度及术后泌乳功能的恢复,有良好的临床推广应用前景。

Objective To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)on patient comfort and lactation after cesarean section.Methods One hundred and twenty-five women taking selective cesarean section at Guizhou People's Hospital from November 2020 to July 2021 were selected;90 ones met the inclusion criteria;they were 18-35 years old and were 37-41 weeks singleton pregnant;the American Society of Anesthesiologists(ASA)classification wasⅠorⅡ;their body weight was 50-90 kg.Using the random number table method,the patients were divided into a transcutaneous electrical acupoint stimulation group(TEAS group),a patient-controlled epidural analgesia group(PCEA group),and a control group,with 30 cases in each group.The postoperative Visual Analogue Scale(VAS)was used to record the pain situation.The postoperative analgesic recovery rates 1 to 3 days after cesarean section were recorded.The beginning time of lactation after cesarean section was recorded.The lactation sufficiency rates 1 to 3 days after cesarean section were evaluated.The serum prolactin and dopamine contents before and 1 to 3 days after cesarean section were detected.The incidences of nausea and vomiting 1 to 3 days after cesarean section and the first anal exhaust time were recorded.The QoR-40 Scale was used to evaluate the recovery quality 1 to 3 days after cesarean section.One-way ANOVA,Kruskal-Wallis test,andχ^(2) test were used for the comparison between the groups.Results The VAS scores and the incidences of nausea and vomiting after cesarean section in the TEAS group and the PCEA group were much lower in those in the control group(all P<0.05).The QoR-40 scores after cesarean section in the TEAS group and the PCEA group were higher than that in the control group(both P<0.05).There was no statistical difference in the QoR-40 score between the TEAS group and the PCEA group.The beginning time of lactation after cesarean section and lactation sufficiency rate were(23.63±1.94)h and 93.3%(28/30)in the TEAS group,were(35.77±3.09)h and 83.3%(25/30)in the PCEA group,and were(41.70±2.52)h and 66.7%(20/30)in the control group.The beginning time of lactation after cesarean section and lactation sufficiency rate in the TEAS group were better than those in the PCEA group and the control group(all P<0.05).The serum prolactin content in the TEAS group was better than those in the PCEA group and the control group(both P<0.05).The first anal exhaust time and serum dopamine content in the TEAS group were lower than those in the PCEA group and the control group(all P<0.05).Conclusions TEAS is a good choice for cesarean section patients,and can improve the patient comfort and their lactation function.There is a bright prospect for TEAS clinical application.