Wang Hui, Yang Bao-Zhong, Guo Qi, Jing Zi-Ye
College of Anesthsiology, Shanxi Medical University, Taiyuan 030001, China.
Department of Anesthsiology, The First Hospital of Shanxi Medical University, Taiyuan 030001.
Zhen Ci Yan Jiu. 2021 Mar 25;46(3):231-4. doi: 10.13702/j.1000-0607.200249.
To observe the effect of transcutaneous electrical acupoint stimulation (TEAS)combined with epidural analgesia on postpartum depression and to explore its underlying mechanism.
One hundred and twenty cases of full-term primiparous women with singleton pregnancy were selected from May 2018 to November 2018 in Jinzhong Maternal and Child Health Hospital. The parturients with labor analgesia requirement were randomly divided into the epidural group and the combination group, and the parturients without labor analgesia requirement were used as the control group, with 40 cases in each group. Patients in the control group did not receive labor analgesia and were treated according to the routine procedures of natural delivery; patients in the epidural group received epidural labor analgesia; patients in the combination group received TEAS at bilateral Hegu(LI4), Sanyinjiao(SP6) and Zusanli(ST36) (2 Hz/100 Hz, the current intensity is gradually increased from 15 mA, and the treatment was performed every 2 h, 20 min each time) combined with epidural labor analgesia. The visual analogue scale (VAS) scores were recorded when the uterine orifice opened to 3, 6, 8, 10 cm. Plasma glutamate was measured using high-performance liquid chromatography before analgesia, at the end of the third stage of labor and 42 days after delivery, and Edinburgh postnatal depression scale (EPDS) score was measured at 42 days after delivery.
In comparison with the control group, the VAS score, EPDS score and the incidence of postpartum depression of the epidural group and the combination group were significantly lower(<0.05), and the combination group had significant decrease than those in epidural group (<0.05). Immediately before analgesia, there was no statistically significant difference in glutamate levels among the 3 groups (>0.05). Compared with the control group, at the end of the third stage of labor and 42 days postpartum, the glutamate levels of the epidural group and the combination group were significantly reduced(<0.05), and the combination group decreased more significantly than the epidural group (<0.05).
TEAS combined with epidural analgesia can reduce the incidence of postpartum depression, possibly by down-regulating plasma glutamate level and relieving of labor pain.
观察经皮穴位电刺激（TEAS）联合硬膜外镇痛对产后抑郁的影响，并探讨其潜在机制。
选取2018年5月至2018年11月在晋中市妇幼保健院分娩的120例足月单胎初产妇。有分娩镇痛需求的产妇随机分为硬膜外组和联合组，无分娩镇痛需求的产妇作为对照组，每组40例。对照组未接受分娩镇痛，按自然分娩常规程序处理；硬膜外组接受硬膜外分娩镇痛；联合组在双侧合谷（LI4）、三阴交（SP6）和足三里（ST36）接受经皮穴位电刺激（2 Hz/100 Hz，电流强度从15 mA开始逐渐增加，每2小时治疗1次，每次20分钟）联合硬膜外分娩镇痛。宫口开至3、6、8、10 cm时记录视觉模拟评分（VAS）。在镇痛前、第三产程结束时及产后42天采用高效液相色谱法测定血浆谷氨酸水平，在产后42天采用爱丁堡产后抑郁量表（EPDS）评分。
与对照组比较，硬膜外组和联合组的VAS评分、EPDS评分及产后抑郁发生率均显著降低（<0.05），联合组较硬膜外组显著降低（<0.05）。镇痛前，3组谷氨酸水平差异无统计学意义（>0.05）。与对照组比较，第三产程结束时及产后42天，硬膜外组和联合组谷氨酸水平显著降低（<0.05），联合组较硬膜外组降低更显著（<0.05）。
经皮穴位电刺激联合硬膜外镇痛可降低产后抑郁的发生率，可能是通过下调血浆谷氨酸水平及减轻分娩疼痛实现的。
