穴位神经刺激联合患者自控硬脊膜外腔镇痛在潜伏期分娩镇痛中的应用  

Application of acupoint nerve stimulation combined with patient-controlled epidural analgesia in latent phase of the labor

作　　者：赵继蓉[1] 罗威[1] 李胜华[1] ZHAO Jirong;LUO Wei;LI Shenghua(Department of Anesthesiology,Jiading Matemal and Child Health Hospital,Shanghai 201821,China)

机构地区：[1]上海市嘉定区妇幼保健院麻醉科,上海201821

出　　处：《上海医学》2018年第5期284-288,共5页Shanghai Medical Journal

基　　金：2015年嘉定区卫生计生委中医类科研立项项目(2015-KY-ZYY-04)

摘　　要：目的观察韩氏穴位神经刺激仪(HANS)联合患者自控硬脊膜外腔镇痛(PCEA)应用于潜伏期分娩镇痛的效果。方法选择2016年9月—2017年3月在上海市嘉定区妇幼保健院分娩的初产妇120例,年龄22～30岁,有经阴道分娩的适应证,无椎管内阻滞禁忌证,足月、单胎、头位,进入潜伏期(有规则宫缩,宫口开1cm),要求分娩镇痛。将其随机等分为HANS组、PCEA组和HANS+PCEA组,每组40例。再配对选择40例同期未行分娩镇痛的初产妇作为对照组。比较4组产妇的镇痛效果、镇痛药物用量、PCEA按压有效比例(有效按压次数/总按压次数)、产程时间、分娩方式选择情况,镇痛对分娩、新生儿的影响,以及产妇满意度。结果 HANS组、PCEA组和HANS+PCEA组镇痛后各时间点的疼痛VAS评分均显著低于同组镇痛前和对照组同时间点(P值均<0.05),PCEA组和HANS+PCEA组镇痛后各时间点的疼痛VAS评分均显著低于HANS组同时间点(P值均<0.05)。PCEA组产妇的平均用药量(总用药量/分娩镇痛总时间)显著多于HANS+PCEA组(P<0.05),PCEA按压有效比例显著低于HANS+PCEA组(P<0.05)。HANS+PCEA组的第一产程显著短于对照组、HANS组和PCEA组(P值均<0.05);PCEA组的第一产程显著短于HANS组和对照组(P值均<0.05),第二产程显著长于对照组、HANS组和HANS+PCEA组(P值均<0.05)。4组间自然分娩、器械助产、剖宫产的产妇比例,产妇产后2h内出血量,以及新生儿出生后1min的Apgar评分的差异均无统计学意义(P值均>0.05)。PCEA组产妇催产素使用率显著高于对照组、HANS和HANS+PCEA组(P值均<0.05)。HANS+PCEA组满意度为优的产妇比例显著高于对照组、HANS组和PCEA组(P值均<0.05)。结论 HANS联合PCEA能有效地减轻分娩疼痛,减少局部麻醉药用量,缩短第二产程,提高产妇满意度。Objective To observe the clinical outcomes of acupoint neurostimulator （HANS） combined with patient controlled epidural analgesia （PCEA） in latent phase of the labor. Methods A total of 120 full-term cephalic single birth primiparas aged from 22 to 30 years old, who delivered their children in Jiading Maternal and Child Health Hospital from September 2016 to March 2017, were enrolled in this study. They had the indications for vaginal delivery but no contraindications for intrathecal block, were entering the latent phase of labor （regular contractions, cervix opening more than 1 cm）, and asked for labor analgesia. They were randomized into 3 groups （n = 40） ： HANS group, PCEA group, and HANS plus PCEA group, In addition, 40 matched primiparas who did not undergo labor analgesia during the same period were selected for control group. The analgesic effect, the consumption of analgesics, PCEA efficacy, delivery time, delivery way, influence of analgesia for delivery and newborns, and maternal satisfaction were compared between groups. Results The visual analogue scale （VAS） scores after analgesia in HANS group, PCEA group and HANS plus PCEA group were significantly lower than those in the corresponding group before analgesia and those in control group after analgesia （all P〈0.05）. The VAS scores in PCEA group and HANS plus PCEA group were significantly lower than those in HANS group at the same time point （all P〈0.05）. The consumption of analgesics in the PCEA group was significantly greater than that in the HANS plus PCEA group （P〈0.05）, while the efficacy in the PCEA group was significantly lower than that in the HANS plus PCEA group （P〈0.05）. The first stage of labor in the HANS plus PCEA group was significantly shorter than those in the other three groups （all P〈0. 05）. The first stage of labor in the PCEA group was significantly shorter than those in the HANS group and control group （both P〈0.05）. The second stage of labor in the PCEA group was significa

关 键 词：潜伏期分娩镇痛 穴位神经刺激仪 自控硬脊膜外腔镇痛 产妇满意度 

分 类 号：R714.3[医药卫生—妇产科学]