Nabb Mary T Mc, Kimber Linda, Haines Anne, McCourt Christine
Faculty of Health and Social Care Sciences, Kingston University & St George's Hospital Medical School, St George's Hospital, Cranmer Terrace, London SW17 ORE, UK.
Complement Ther Clin Pract. 2006 Aug;12(3):222-31. doi: 10.1016/j.ctcp.2005.12.006. Epub 2006 Jun 5.
The present study was undertaken to produce a detailed specification of a programme of massage, controlled breathing and visualization performed regularly by birth partners, from 36 weeks gestation and assisted by a trained professional, following hospital admission during labour and birth. As current research on massage interventions for pain relief in labour is poorly characterized, we began by undertaking a feasibility study on an established massage programme [Goldstone LA. Massage as an orthodox medical treatment past and future. Complementary Therapies in Nursing & Midwifery. 2000;6:169-75]. The intervention was designed in light of experimental findings that repeated massage sessions over 14 days increases pain threshold, by an interaction between oxytocin and opioid neurons [Lund I, Yu L-C, Uvnas-Moberg K, Wang J, Yu C, Kurosawa M, et al. Repeated massage-like stimulation induces long-term effects on nociception: contribution of oxytocinergic mechanisms. European Journal of Neuroscience 2002;16:330-8]. A 4 week time-frame was selected to coincide with a physiological increase in maternal pain threshold [Cogan R, Spinnato JA. Pain and Discomfort Thresholds in Late Pregnancy. Pain 1986;27:63-8, Whipple B, Josimovich JB, Komisaruk BR. Sensory thresholds during the antepartum, intrapartum, and postpartum periods. International Journal of Nursing Studies 1990;27(3):213-21, Gintzler AR, Komisaruk BR. Analgesia is produced by uterocervical mechano-stimulation in rats: roles of afferent nerves and implications for analgesia of pregnancy and parturition. Brain Research 1991;566:299-302, Gintzler AR, Liu N-J. The maternal spinal cord: biochemical and physiological correlates of steroid-activated antinociceptive processes. In: Russell JA, Douglas AJ, Windle RJ, Ingram CD, editors., Progress in Brain Research. Volume 133. The Maternal Brain. Neurobiological and Neuroendocrine adaptation and disorders in pregnancy and postpartum. Amsterdam: Elsevier Science, 2001. p. 83-97]. The main objective was to measure the effects of the programme on maternal pain perception during labour and birth. To detect any effect of massage during labour, on maternal cortisol and catecholamines, cord venous blood was taken to measure plasma concentrations following birth. Twenty-five nulliparous (N) and 10 multiparous (M) women participated in the study. Cortisol values were similar to published studies following labour without massage but pain scores on a Visual Analogue Scale (VAS), at 90min following birth were significantly lower than scores recorded 2 days postpartum [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35]. The mean score was 6.6. Previous studies suggest that a reduction from 8.5 to 7.5 would significantly reduce pharmacological analgesia in labour [Capogna G, Alahuhta S, Celleno D, De Vlieger H, Moreira J, Morgan B, et al. Maternal expectations and experiences of labour pain and analgesia: a multi-centre study of nulliparous women. International Journal of Obstetric Anaesthesia 1996;5:229-35].
本研究旨在制定一份详细的方案,内容包括由分娩陪伴者在妊娠36周开始定期进行的按摩、控制呼吸和想象练习,并在分娩和生产期间住院后由专业培训人员提供协助。由于目前关于分娩时按摩干预缓解疼痛的研究特征不明确,我们首先对一个既定的按摩方案进行了可行性研究[戈德斯顿LA。按摩作为一种正统的医学治疗方法的过去和未来。《护理与助产中的补充疗法》。2000;6:169 - 75]。该干预措施是根据实验结果设计的,即14天内重复进行按摩疗程可通过催产素和阿片样物质神经元之间的相互作用提高疼痛阈值[伦德I,于L - C,乌夫纳斯 - 莫伯格K,王J,于C,黑泽M等。重复的类似按摩刺激对痛觉产生长期影响:催产素能机制的作用。《欧洲神经科学杂志》2002;16:330 - 8]。选择了4周的时间框架,以与产妇疼痛阈值的生理性升高相吻合[科根R,斯皮纳托JA。妊娠晚期的疼痛和不适阈值。《疼痛》1986;27:63 - 8,惠普尔B,乔西莫维奇JB,科米萨鲁克BR。产前、产时和产后的感觉阈值。《国际护理学研究杂志》1990;27(3):213 - 21,金茨勒AR,科米萨鲁克BR。子宫颈机械刺激在大鼠中产生镇痛作用:传入神经的作用及其对妊娠和分娩镇痛的意义。《脑研究》1991;566:299 - 302,金茨勒AR,刘N - J。母体脊髓:类固醇激活的抗痛觉过程的生化和生理相关性。载于:拉塞尔JA,道格拉斯AJ,温德尔RJ,英格拉姆CD主编。《脑研究进展》。第133卷。《母体大脑》。妊娠和产后的神经生物学和神经内分泌适应与紊乱。阿姆斯特丹:爱思唯尔科学出版社,2001。第83 - 97页]。主要目的是测量该方案对分娩和生产期间产妇疼痛感知的影响。为了检测分娩期间按摩对产妇皮质醇和儿茶酚胺的任何影响,在出生后采集脐带静脉血以测量血浆浓度。25名初产妇(N)和10名经产妇(M)参与了该研究。皮质醇值与未进行按摩的分娩后已发表的研究结果相似,但出生后90分钟时视觉模拟评分法(VAS)的疼痛评分显著低于产后2天记录的评分[卡波尼亚G,阿拉胡塔S,切莱诺D,德弗利格H,莫雷拉J,摩根B等。产妇对分娩疼痛和镇痛的期望与体验:一项对初产妇的多中心研究。《国际产科麻醉杂志》1996;5:229 - 35]。平均评分为6.6。先前的研究表明,从8.5降至7.5将显著减少分娩时的药物镇痛[卡波尼亚G,阿拉胡塔S,切莱诺D,德弗利格H,莫雷拉J,摩根B等。产妇对分娩疼痛和镇痛的期望与体验:一项对初产妇的多中心研究。《国际产科麻醉杂志》1996;5:229 - 35]。
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