Li Mao-Jun, Wang Jian, Wei Bin-Xiu, Deng Qiu-Xia, Zhu Xiao-Dong, Zhang Ying
Department of Anesthesiology, Linshui County People's Hospital, Linshui 638500, Sichuan Province, China.
Department of Anesthesiology, Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou 646000, Sichuan Province.
Zhen Ci Yan Jiu. 2020 Apr 25;45(4):325-9. doi: 10.13702/j.1000-0607.190448.
To investigate the effect of electroacupuncture (EA) analgesia at the latent stage of labor on epidural analgesia, labor outcome and neonatal score so as to provide the reference to the clinical labor analgesia.
According to the random number table, 104 primipara of vaginal delivery were divided into three groups, named an EA group (37 cases), a sham-EA group (36 cases) and an epidural block group (31 cases). In the EA group, when the cervix opened up by 1 cm, Han's acupoint nerve stimulation apparatus was attached to bilateral Hegu (LI4) and bilateral Sanyinjiao (SP6) to achieve EA analgesia till the active stage (the cervix up 3 cm). In the sham-EA group, the procedure was same as the EA group, but with the sham-stimulation. In the epidural block, EA was not used in intervention. When the cervix opened up 3 cm, the epidural block and the patient-controlled epidural analgesia were all adopted in each group. The score of visual analogue scale (VAS) and the dosage of Sufentanil and Ropivacaine in patient-controlled analgesia pump at the different time points were compared among the groups. Respectively, in 1 h of EA stimulation (T1), 2 h of EA stimulation (T2), at the moment of epidural block (T3) and the complete open of the cervix (T6), the venous blood sample was collected to determine the concentration of beta-endorphin (beta-EP), and the use time of oxytocin, the bleeding amount and the state of newborn were recorded.
There was no statistical difference in immediate of EA stimulation (T0) among the groups in VAS score (>0.05). But, in T1 to T6, VAS score in the EA group was reduced obviously as compared with the sham-EA group and the epidural block group separately (<0.05). There was no statistical difference in the use time of oxytocin among the three groups (>0.05). In the sham-EA group and the epidural block group, bleeding amount during labor and in 24 h after labor was all higher than that of the EA group (<0.05). In each group, the concentration of beta-EP in T3 and T6 was increased obviously as compared with that in T1 and T2 respectively (<0.05). In the EA group, the concentration of beta-EP in T1 to T3 and in T6 was higher than that in sham-EA group and the epidural block group respectively (<0.05). The dosage of Ropivacaine and Sufentanil in the EA group was less than that in either the sham-EA group or the epidural block group (<0.05). There was no significant difference in amniotic fluid turbidity rate and Apgar score among the three groups (>0.05).
Electroacupuncture analgesia at the latent stage of labor effectively relieves labor pain of primipara, increases the concentration of beta-EP, enhances the effect of epidural block analgesia, reduces labor bleeding and has no side effect on newborn. The combination of electroacupuncture analgesia and the epidural anesthesia in the latent stage is applicable in the whole process of labor.
探讨分娩潜伏期电针镇痛对硬膜外镇痛、分娩结局及新生儿评分的影响，为临床分娩镇痛提供参考。
将104例阴道分娩初产妇按随机数字表法分为电针组（37例）、假电针组（36例）和硬膜外阻滞组（31例）。电针组在宫颈口开大1 cm时，将韩氏穴位神经刺激仪连接于双侧合谷（LI4）和双侧三阴交（SP6）行电针镇痛至活跃期（宫颈口开大3 cm）。假电针组操作同电针组，但给予假刺激。硬膜外阻滞组不采用电针干预。当宫颈口开大3 cm时，各组均采用硬膜外阻滞及患者自控硬膜外镇痛。比较各组不同时间点视觉模拟评分（VAS）及患者自控镇痛泵中舒芬太尼和罗哌卡因用量。分别于电针刺激1 h（T1）、电针刺激2 h（T2）、硬膜外阻滞即刻（T3）及宫颈口开全时（T6）采集静脉血样测定β-内啡肽（β-EP）浓度，记录缩宫素使用时间、出血量及新生儿情况。
各组电针刺激即刻（T0）VAS评分比较，差异无统计学意义（>0.05）。但在T1～T6时，电针组VAS评分分别明显低于假电针组和硬膜外阻滞组（<0.05）。三组缩宫素使用时间比较，差异无统计学意义（>0.05）。假电针组和硬膜外阻滞组产时及产后24 h出血量均高于电针组（<0.05）。各组T3、T6时β-EP浓度分别明显高于T1、T2时（<0.05）。电针组T1～T3及T6时β-EP浓度分别高于假电针组和硬膜外阻滞组（<0.05）。电针组罗哌卡因和舒芬太尼用量均少于假电针组和硬膜外阻滞组（<0.05）。三组羊水浑浊率及Apgar评分比较，差异无统计学意义（>0.05）。
分娩潜伏期电针镇痛可有效减轻初产妇分娩疼痛，提高β-EP浓度，增强硬膜外阻滞镇痛效果，减少分娩出血，且对新生儿无不良影响。分娩潜伏期电针镇痛与硬膜外麻醉联合应用适用于分娩全过程。
