耳穴压豆法联合硬膜外分娩镇痛对产妇儿茶酚胺水平的影响  

Effects of ear acupoint pressing bean method combined with epidural labor analgesia for labor analgesia on the levels of catecholamine of puerpera

作　　者：陈亮[1] 秦泽 赵海峰[1] 赵会兰[1] 闫静 石会静 毛慧敏[1] CHEN Liang;QIN Ze;ZHAO Haifeng(The Fourth Hospital of Shijiazhuang City,Hebei,Shijiazhuang 050011,China)

机构地区：[1]河北省石家庄市第四医院,050011

出　　处：《河北医药》2021年第9期1343-1346,共4页Hebei Medical Journal

基　　金：河北省中医药管理局科研计划项目(编号:2019467)。

摘　　要：目的探讨耳穴压豆法联合硬膜外分娩镇痛对产妇儿茶酚胺(肾上腺素、去甲肾上腺素、多巴胺、β-内啡肽)的影响。方法收治的200例足月单胎初产妇,按单双日随机分为耳穴+硬膜外组(A+E组,单日)和硬膜外组(E组,双日),每组100例。A+E组在潜伏期行耳穴贴压法分娩镇痛,E组潜伏期无任何镇痛方法,2组在活跃期均行硬膜外分娩镇痛。比较2组产妇的中转剖宫产率及新生儿Apgar评分,记录第一产程时间、硬膜外镇痛药总量、潜伏期及活跃期疼痛评分、产妇镇痛满意度。潜伏期开始(T0)、实施硬膜外分娩镇痛前(T1)、硬膜外分娩镇痛30 min后(T2)、胎儿娩出后(T3)、胎儿娩出后24 h(T4)各时间点抽取静脉血,检测血浆皮质醇(Cor)、肾上腺素(A)、去甲肾上腺素(NA)、多巴胺(DA)和β-内啡肽(β-EP)水平。结果2组产妇年龄、体重、孕周、第一产程时间、中转剖宫产率,新生儿体重、Apgar评分(1 min、5 min)差异均无统计学意义(P>0.05)。A+E组硬膜外镇痛药总量的明显低于E组(P<0.05)。A+E组镇痛满意度高于E组(P<0.05)。与E组比较,A+E组潜伏期和活跃期VAS评分均低于E组(P<0.05)。与T0时比较,T3时2组Cor、A、NA水平显著降低,A+E组DA水平显著降低(P<0.05);T2时A+E组Cor、A、NA、DA水平降低,E组A、NA水平降低(P<0.05),E组Cor水平升高(P<0.05);T1时A+E组A、NA、DA水平降低(P<0.05),2组Cor水平及E组NA水平升高(P<0.05);T1、T2、T3时2组β-EP水平升高、T4时β-EP水平降低(P<0.05)。与T1时比较,T2、T3时2组Cor、A、NA水平降低,T4时2组Cor水平降低(P<0.05);T4时A+E组A、NA水平升高(P<0.05)。与E组比较,T1、T2、T3时A+E组Cor、A水平降低(P<0.05),T1时A+E组NA水平明显降低(P<0.05);T1、T2、T3时A+E组β-EP水平显著增高(P<0.05)。结论耳穴压豆法联合硬膜外分娩镇痛在潜伏期可为产妇提供良好的镇痛,不增加产程,对新生儿无不良影响;可预防过度应激反应造成的的交感神经�Objective To investigate the analgesic effects of ear acupoint pressing bean method combined with epidural labor analgesia for labor analgesia,and to explore its effects on catecholamines in puerpera at different time points.Methods A total of 200 full term single birth primipara who were admitted into our hospital from may 2016 to may 2018 were randomly divided into auricular point+epidural group(A+E group)and epidural analgesia group(group E),with 100 cases in each group.The primipara in A+E group were treated by auricular point plaster therapy for labor analgesia at latent phase,however,the primipara in group E were not treated by analgesia method at latent phase.All of the subjects received epidural labor analgesia after entering the active phase.The cesarean section rate and Apgar score of neonates,and the time of first stage of labor,total amount of epidural analgesics,pain score in 1atent and active phase and satisfaetion degree of analgesia were observed and compared between the two groups.Moreover the plasma levels of cortisol(COR),epinephrine(A),norepinephrine(NA),dopamine(DA)andβ-endorphinin(β-EP)were detected at different time points.Results There were no significant differences in primipara’age,weight,gestational week,time of first stage of labor,rate of conversion to cesarean section,neonatal weight,Apgar score(1min,5min)between the two groups(P>0.05).The total amount of epidural analgesia in group A+E was significantly lower than that in group E(P<0.05).The analgesic satisfaction degree in A+E group was significantly higher than that in group E(P<0.05).The VAS scores in group A+E were significantly lower than those in group E(P<0.05).The plasma levels of Cor,A and DA at T3 in both groups were significantly lower than those at T0(P<0.05).And the levels of Cor,A,NA and DA at T2 were significantly lower than those at T0 in group A+E(P<0.05),and in the plasma levels of A,NA,DA at T1 were significantly lower than those at T0(P<0.05).The levels ofβ-EP concenttrations at T1,T2,T3 in both groups were

关 键 词：耳穴压豆法 分娩镇痛 肾上腺素 去甲肾上腺素 多巴胺 

分 类 号：R715.7[医药卫生—妇产科学]