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经皮穴位电刺激(TEAS)作为分娩疼痛镇痛干预措施的疗效与安全性:一项随机对照试验的网状Meta分析

Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) As An Analgesic Intervention for Labor Pain: A Network Meta-analysis of Randomized Controlled Trials.

作者信息

Yan Wenli, Kan Zunqi, Yin Jiahui, Ma Yuxia

机构信息

College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China.

Department of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Shandong, China.

出版信息

Pain Ther. 2023 Jun;12(3):631-644. doi: 10.1007/s40122-023-00496-z. Epub 2023 Mar 19.


DOI:10.1007/s40122-023-00496-z
PMID:36934401
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10199978/
Abstract

INTRODUCTION: Epidural analgesia (EA) is the most widely used intervention for the reduction of labor pain; however, it is contra-indicated for patients with spinal deformity or allergy to anesthetics and may be refused by parturients. As a noninvasive and nonnarcotic analgesic intervention, transcutaneous electrical acupoint stimulation (TEAS) has gained increasing attention in recent years. Therefore, we performed a network meta-analysis to compare the efficacy and safety of TEAS and EA as measured by visual analog scale score, the failure rate of natural delivery, adverse events, and Apgar scores. METHODS: Relevant randomized controlled trials (RCTs) from four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane CENTRAL) and clinical trials.gov were searched from inception until September 4, 2022. A random effects model was used during analysis, and outcomes were evaluated as standard mean difference (SMD), odds ratio (OR), and 95% confidence intervals (CrI) using STATA (version SE15.0), R (version 3.6.1), and ADDIS (version 1.16.8) software. RESULTS: Ten RCTs comprising 1214 parturients were identified by screening. Six RCTs compared TEAS and controls, three compared EA and controls, and one compared TEAS and EA. No heterogeneity was found within the four outcomes. There was no significant difference in any outcomes between interventions or control treatments in terms of SMD, OR, and CrI. Combined with the highest surface under the cumulative ranking curve score, TEAS demonstrated possible better effects in the aspects of analgesic efficacy and safety under certain circumstances. CONCLUSIONS: TEAS may be a potential alternative for parturients as a simple, noninvasive, and non-pharmacological intervention compared with EA in terms of analgesic efficacy and safety for mothers and neonates.

摘要

引言:硬膜外镇痛(EA)是减轻分娩疼痛最广泛使用的干预措施;然而,它对于脊柱畸形或对麻醉剂过敏的患者是禁忌的,并且可能会被产妇拒绝。作为一种非侵入性和非麻醉性的镇痛干预措施,经皮穴位电刺激(TEAS)近年来越来越受到关注。因此,我们进行了一项网状Meta分析,以比较TEAS和EA在视觉模拟量表评分、自然分娩失败率、不良事件和阿氏评分方面的疗效和安全性。 方法:检索了四个电子数据库(PubMed、EMBASE、科学网和Cochrane CENTRAL)以及ClinicalTrials.gov中从创建到2022年9月4日的相关随机对照试验(RCT)。分析过程中使用随机效应模型,并使用STATA(版本SE15.0)、R(版本3.6.1)和ADDIS(版本1.16.8)软件将结果评估为标准化均数差(SMD)、比值比(OR)和95%置信区间(CrI)。 结果:通过筛选确定了10项RCT,共纳入1214名产妇。其中6项RCT比较了TEAS与对照组,3项比较了EA与对照组,1项比较了TEAS与EA。在四个结局指标中均未发现异质性。在SMD、OR和CrI方面,干预组与对照组在任何结局指标上均无显著差异。结合累积排序曲线下面积得分最高的情况,TEAS在某些情况下在镇痛效果和安全性方面可能具有更好的效果。 结论:与EA相比,TEAS作为一种简单、非侵入性和非药物的干预措施,在对母亲和新生儿的镇痛效果和安全性方面,可能是产妇的一种潜在替代方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/16d139c489b2/40122_2023_496_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/0a249b18f760/40122_2023_496_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/511f52306e83/40122_2023_496_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/4a537b4d8e04/40122_2023_496_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/16d139c489b2/40122_2023_496_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/0a249b18f760/40122_2023_496_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/511f52306e83/40122_2023_496_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/4a537b4d8e04/40122_2023_496_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f71f/10199978/16d139c489b2/40122_2023_496_Fig4_HTML.jpg

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本文引用的文献

[1]
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Pain Res Manag. 2022

[2]
Is a single dose of commonly used antibiotics effective in preventing maternal infection after cesarean section? A network meta-analysis.

PLoS One. 2022

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Evidence on acupuncture therapies is underused in clinical practice and health policy.

BMJ. 2022-2-25

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Effects of non-pharmacological coping strategies for reducing labor pain: A systematic review and network meta-analysis.

PLoS One. 2022-1-21

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Pregabalin and Gabapentin in Patients with Spinal Cord Injury-Related Neuropathic Pain: A Network Meta-Analysis.

Pain Ther. 2021-12

[6]
[Effect of transcutaneous electrical acupoint stimulation on epidural-related maternal fever in parturients undergoing epidural labor analgesia].

Zhen Ci Yan Jiu. 2021-7-25

[7]
[Effect of transcutaneous electrical acupoint stimulation combined with epidural labor analgesia on postpartum depression].

Zhen Ci Yan Jiu. 2021-3-25

[8]
Electroacupuncture preserves intestinal barrier integrity through modulating the gut microbiota in DSS-induced chronic colitis.

Life Sci. 2020-9-21

[9]
Transcutaneous Electrical Nerve Stimulation As A Pain-Relieving Approach in Labor Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Neuromodulation. 2020-8

[10]
[Effect of transcutaneous electrical acupoint stimulation on labor analgesia].

Zhongguo Zhen Jiu. 2020-6-12

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