Smith Caroline A, Collins Carmel T, Crowther Caroline A, Levett Kate M
Centre for Complementary Medicine Research, University of Western Sydney, Locked Bag 1797, Penrith South DC, New South Wales, Australia, 2751.
Cochrane Database Syst Rev. 2011 Jul 6(7):CD009232. doi: 10.1002/14651858.CD009232.
Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour.
To examine the effects of acupuncture and acupressure for pain management in labour.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to October 2010), and CINAHL (1980 to October 2010).
Published and unpublished randomised controlled trials comparing acupuncture and acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether primiparous or multiparous, and in spontaneous or induced labour.
We performed meta-analysis using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The outcome measures included pain intensity, satisfaction with pain relief, use of pharmacological pain relief, relaxation, caesarean section rate, augmentation with oxytocin, length of labour and anxiety.
We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention (standardised mean difference (SMD) -1.00, 95% confidence interval (CI) -1.33 to -0.67, one trial, 163 women). One trial increased satisfaction with pain relief compared with placebo control (RR 2.38, 95% CI 1.78 to 3.19, 150 women). Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (RR 0.72, 95% CI 0.58 to 0.88, 136 women), and compared with standard care, however, there was significant heterogeneity (RR 0.68, 95% CI 0.56 to 0.83, three trials, 704 women). Fewer instrumental deliveries from acupuncture were found compared with standard care (RR 0.67, 95% CI 0.46, 0.98, three trials, 704 women); however, there was significant heterogeneity. Pain intensity was reduced in the acupressure group compared with a placebo control (SMD -0.55, 95% CI -0.92 to -0.19, one trial, 120 women), and a combined control (SMD -0.42, 95% CI -0.65 to -0.18, two trials, 322 women). No trial was assessed as being at a low risk of bias for all of the quality domains.
AUTHORS' CONCLUSIONS: Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.
许多女性希望避免在分娩时使用药物或侵入性疼痛管理方法，这可能促使补充性疼痛管理方法受到欢迎。本综述研究了支持针灸和指压用于分娩疼痛管理的证据。
研究针灸和指压用于分娩疼痛管理的效果。
我们检索了Cochrane妊娠与分娩组试验注册库以及Cochrane补充医学领域试验注册库（2010年10月）、Cochrane对照试验中心注册库（《Cochrane图书馆》2010年第4期）、MEDLINE（1966年至2010年10月）以及CINAHL（1980年至2010年10月）。
比较针灸和指压与安慰剂、不治疗或其他分娩疼痛管理非药物形式的已发表和未发表随机对照试验。我们纳入了所有女性，无论初产妇还是经产妇，以及自然分娩或引产的女性。
我们使用风险比（RR）对二分结果进行荟萃分析，使用均值差（MD）对连续结果进行荟萃分析。结局指标包括疼痛强度、对疼痛缓解的满意度、药物性疼痛缓解的使用情况、放松程度、剖宫产率、催产素引产、产程长度和焦虑程度。
我们纳入了13项试验，涉及1986名女性的数据报告。9项试验报告了针灸，4项试验报告了指压。与不干预相比，针灸组疼痛强度较低（标准化均值差（SMD）-1.00，95%置信区间（CI）-1.33至-0.67，1项试验，163名女性）。与安慰剂对照相比，1项试验中对疼痛缓解的满意度增加（RR 2.38，95%CI 1.78至3.19，150名女性）。与安慰剂相比，1项针灸试验中药物性镇痛的使用减少（RR 0.72，95%CI 0.58至0.88，136名女性），但与标准护理相比，存在显著异质性（RR 0.68，95%CI 0.56至0.83，3项试验，704名女性）。与标准护理相比，针灸组器械助产较少（RR 0.67，95%CI 0.46，0.98，3项试验，704名女性）；然而，存在显著异质性。与安慰剂对照相比，指压组疼痛强度降低（SMD -0.55，95%CI -0.92至-0.19，1项试验，120名女性），与联合对照相比（SMD -0.42，95%CI -0.65至-0.18，2项试验，322名女性）。没有一项试验在所有质量领域被评估为低偏倚风险。
针灸和指压在减轻疼痛、提高对疼痛管理的满意度以及减少药物管理使用方面可能有作用。然而，需要进一步研究。
