经皮穴位神经电刺激联合硬膜外镇痛在产妇自然分娩中的应用

Efficacy of transcutaneous electrical nerve stimulation combined with epidural analgesia in parturients during natural childbirth

目的 观察经皮穴位神经电刺激联合硬膜外镇痛在产妇自然分娩中的临床效果并探讨其作用机制.方法 拟行自然分娩待产妇300例,按随机数字表法分为3组:活跃期硬膜外阻滞镇痛组(A组)、全产程硬膜外阻滞镇痛组(B组)及经皮穴位神经电刺激联合活跃期硬膜外镇痛组(C组).记录各组产妇不同评价时点VAS评分、产程时间、产后出血量及新生儿Apgar评分,并于临产时和宫口开全时取肘静脉血样测产妇外周血浆强啡肽(DYN)、皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)和血糖浓度.结果 B、C两组潜伏期各时点VAS评分明显低于A组(P＜0.05);A、C两组第一产程时间短于B组(P＜0.05);各组产后出血量和新生儿Apgar评分差异无统计学意义(P＞0.05).与临产时比较,各组产妇宫口开全时血浆DYN、Cor、NE、E及血糖浓度均升高(P＜0.05);B、C两组宫口开全时DYN较A组明显升高(P＜0.05),Cor、NE、E及血糖浓度较A组明显降低(P＜0.05).结论 经皮穴位神经电刺激联合硬膜外阻滞全产程镇痛可提高产妇的分娩镇痛效果,缩短产程时间,其机制可能与血浆DYN含量增加及减轻应激反应有关.

Objective To investigate the efficacy of transcutaneous electrical nerve stimulation (TENS) combined with epidural analgesia in parturients during natural childbirth.Methods Three hundred parturients were randomly divided into three groups:epidural labor analgesia in parturients during active stage (group A),epidural labor analgesia in total stages of labor (group B) and TENS combined with epidural labor analgesia in active stage (group C).VAS at different times,labor time,volume of postpartum hemorrhage and Apgar score were recorded.Venous blood samples were taken from all groups at the time in labor and complete cervical dilation to test the concentrations of dynorphin (DYN),cortisol (Cor),norepinephrine (NE),epinephrine (E) and blood sugar.Results VAS in group B and C was significantly lower than that in group A at each time point in latent stage of labor (P＜0.05).The time at the first stage of labor in group A and C was shorter than that in group B (P＜0.05).There was no significant difference in the volume of postpartum hemorrhage and Apgar score among the three groups (P＞0.05).The concentration of DYN,Cor,NE,E and blood sugar increased in all groups at the time in complete cervical dilation as compared with the time in labor (P＜0.05).The concentration of DYN in group B and C was higher than that in group A at the time in complete cervical dilation,while the concentration of Cor,NE,E and blood sugar was lower (P＜0.05).Conclusion TENS combined with epidural analgesia can improve the efficacy of labor analgesia and shorten the stage of labor.The mechanism may be associated with the increase of plasma DYN content and the reduction of stress responses.