摘要
目的评价经皮穴位电刺激(TEAS)联合硬膜外阻滞用于子痫前期产妇分娩镇痛的效果.方法足月、单胎、头位妊娠的子痫前期产妇120例,年龄24~37岁,身高157~171cm,体重66~105kg,ASA分级Ⅲ级,采用随机数字表法分为3组(n=40):活跃期硬膜外分娩镇痛组(A组)、潜伏期硬膜外分娩镇痛组(B组)和TEAS联合活跃期硬膜外分娩镇痛组(C组).A组第一产程活跃期(宫口≥3cm)开始行硬膜外分娩镇痛.B组第一产程潜伏期(宫口≥1cm)开始行硬膜外分娩镇痛.C组第一产程潜伏期开始行TEAS,主穴为双侧合谷和三阴交穴,配穴为足三里穴,选择频率为2Hz∕100Hz疏密波刺激,电流强度从15mA开始,增加至引起明显的震颤感且产妇可耐受为宜,胎儿娩出后结束;第一产程活跃期开始行硬膜外分娩镇痛.硬膜外镇痛配方为0.08%罗哌卡因+舒芬太尼0.4μg∕ml的混合液共100ml,背景输注剂量8ml∕h,PCA剂量5ml,锁定时间30min,胎儿娩出后关闭.分别于宫口开至1、2、3、4、10cm和胎儿娩出即刻,记录MAP和VAS评分;记录产程时间、产后出血量、催产素使用情况、剖宫产情况、不良反应及新生儿Apgar评分;分别于宫口开至1和10cm时取静脉血样,采用ELISA法测定血清强啡肽、皮质醇和血浆促肾上腺皮质激素、去甲肾上腺素、肾上腺素的浓度;采用葡萄糖氧化酶法测定血清葡萄糖浓度.结果与C组比较,A组宫口开至2和3cm时VAS评分和MAP升高,宫口开至10cm时血清强啡肽、皮质醇和血糖、血浆促肾上腺皮质激素、去甲肾上腺素和肾上腺素的浓度升高(P<0.05),各产程时间和催产素使用率差异无统计学意义(P>0.05),B组产妇第一产程时间延长,催产素使用率升高,宫口开至10cm时血清强啡肽浓度降低(P<0.05),各时点VAS评分差异无统计学意义(P>0.05).3组产妇产后出血量、剖宫产率、不良反应及新生儿Apgar评分比较差异无统计学意义(P>0.05).结论与活跃期和潜伏期硬膜外分娩镇痛相比,TEAS联合硬膜外阻滞用于子痫前期产妇分娩镇痛的效果更佳.
Objective To evaluate the efficacy of transcutaneous electrical acupoint stimulation(TEAS)combined with epidural block for labor analgesia in parturients with preeclampsia.Methods One hundred and twenty parturients with preeclampsia who were at full term with a singleton fetus in vertex presentation,aged 24-37 yr,weighing 66-105 kg,with height between 157-171 cm,of American Society of Anesthesiologists physical statusⅢ,were divided into 3 groups(n=40 each)using a random number table method:epidural labor analgesia in active phase of labor group(group A),epidural labor analgesia in latent phase of labor group(group B)and TEAS combined with epidural labor analgesia in active phase of labor group(group C).Epidural labor analgesia was performed in active phase of labor(cervical dilatation≥3 cm)in group A and in latent phase of labor(cervical dilatation≥1 cm)in group B.In group C,TEAS was carried out in latent phase of labor,bilateral Hegu and Sanyinjiao acupoints were selected as the main acupoints and Zusanli as the auxiliary acupoints,patients received TEAS with a frequency 2/100 HZ,disperse dense waves,intensity(starting at a voltage of 15 mA)increasing to the maximum current that could be tolerated until delivery of fetus,and epidural labor analgesia was performed when parturients were in active phase of labor.Epidural labor analgesia solution contained the mixture(100 ml)of 0.08%ropivacaine and sufentanil 0.4μg/ml,and the analgesia pump was set up to deliver a 5 ml bolus dose with a 30-min lockout interval and background infusion at 8 ml/h and then turned off after delivery of fetus.Mean arterial pressure and visual analogue scale(VAS)scores were recorded when the cervical dilation was 1,2,3,4 and 10 cm and immediately after delivery.The labor time,volume of postpartum hemorrhage,requirement for oxytocin,cesarean section,adverse reactions and Apgar score of the newborn were recorded.Maternal venous blood samples were collected when the cervical dilation was 1 and 10 cm for determination of the concentrations of dynorphin(DYN)and cortisol in serum and adrenocorticotropic hormone,norepinephrine and epinephrine in plasma(by enzyme-linked immunosorbent assay)and serum glucose concentration(by glucose oxidase method).Results Compared with group C,the VAS scores and mean arterial pressure were significantly increased when the cervical dilation was 2 and 3 cm,the concentrations of DYN,cortisol and blood sugar in serum and adrenocorticotropic hormone,norepinephrine and epinephrine in plasma were increased when the cervical dilation was 10 cm(P<0.05),and no significant change was found in the duration of each phase of labor or requirement for oxytocin in group A(P>0.05),and the duration of the first stage of labor was significantly prolonged,the requirement for oxytocin was increased,the serum concentration of DYN was decreased when the cervical dilation was 10 cm(P<0.05),and no significant change was found in VAS scores at each time point in group B(P<0.05).There was no significant difference in the volume of postpartum hemorrhage,rate of cesarean resection,adverse reactions or Apgar score of the newborn among the three groups(P>0.05).Conclusion Compared with epidural labor analgesia performed in the latent and active phases of labor,TEAS combined with epidural block provides better efficacy for labor analgesia in parturients with preeclampsia.
作者
李莉
吕艳
王冰
崔洪艳
Li Li;Lyu Yan;Wang Bing;Cui Hongyan(Department of Anesthesiology,Tianjin Central Hospital of Gynecology Obstetrics,Tianjin 300100,China;Department of Obstetrics and Gynecology,Tianjin Central Hospital of Gynecology Obstetrics,Tianjin 300100,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2019年第3期357-360,共4页
Chinese Journal of Anesthesiology
基金
天津市卫生行业重点攻关项目(16KG112).
关键词
电刺激疗法
镇痛
硬膜外
分娩疼痛
先兆子痫
Electric stimulation therapy
Analgesia,epidural
Labor pain
Pre-eclampsia
