针刺穴位联合硬膜外分娩镇痛对产后抑郁症的影响  

Effect of the acupuncture at acupoint combined with epidural labor analgesia on postpartum depression

作　　者：刘梦雅 张颖[1] 江勇[2] 徐晖[3] 吕爱俊[1] 王南海[1] LIU Meng-ya;ZHANG Ying;JIANG Yong;XU Hui;Lv Ai-jun;WANG Nan-hai(Department of Anesthesiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004 Department of Anesthesiology,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;Department of Rehabilitation,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;Department of Anesthesiology,The Third People's Hospital of Bengbu,Bengbu Anhui 233000,China)

机构地区：[1]蚌埠医学院第一附属医院麻醉科,安徽蚌埠233004 [2]蚌埠医学院第一附属医院康复科,安徽蚌埠233004 [3]蚌埠医学院附属蚌埠第三人民医院麻醉科,233000

出　　处：《蚌埠医学院学报》2022年第5期603-607,共5页Journal of Bengbu Medical College

基　　金：蚌埠医学院研究生科研创新计划资助项目(Byycx20070);蚌埠医学院第一附属医院领先项目(2019084)。

摘　　要：目的:研究针刺穴位联合硬膜外分娩镇痛对产后抑郁症(PPD)的影响并探讨其机制。方法:选取足月单胎初产妇180例,将无分娩镇痛要求的产妇设为对照组(C组),将有分娩镇痛要求产妇随机分为针刺穴位联合硬膜外分娩镇痛组(SA组)和硬膜外分娩镇痛组(S组),各60例。SA组行针刺三阴交穴、合谷穴联合0.5μg/mL舒芬太尼复合0.08%罗哌卡因硬膜外分娩镇痛;S组行0.5μg/mL舒芬太尼复合0.08%罗哌卡因硬膜外分娩镇痛;C组不实施分娩镇痛,按照自然分娩常规流程处理。记录3组产妇宫口开2 cm时(T_(0))、宫口全开时(T_(1))、胎儿娩出时(T_(2))的视觉疼痛模拟评分(VAS);用双抗体夹心ELISA法检测镇痛前即刻、第三产程末、产后42 d产妇血清中谷氨酸(Glu)水平,并于产后42 d进行爱丁堡产后抑郁量表(EPDS)评分,比较3组产妇PPD发生率。记录T_(0)~T_(2)时,按压镇痛泵及不良反应情况;记录产程、产后2 h出血量、分娩镇痛后Bromage运动评分。结果:3组T_(0)时VAS评分差异无统计学意义(P>0.05),T_(1)和T_(2)时,SA组、S组VAS评分均明显低于C组(P<0.01),SA组亦均明显低于S组(P<0.01)。3组产妇第一产程、第三产程和产后2 h出血量差异均无统计学意义(P>0.05);SA组和C组第二产程均较S组明显缩短(P<0.01),而SA组与C组差异无统计学意义(P>0.05)。SA组、S组产后EPDS评分和PPD发生率均低于C组(P<0.05~P<0.01),SA组EPDS评分和PPD发生率亦均低于S组(P<0.01和P<0.05)。镇痛前即刻,3组产妇血清Glu水平差异无统计学意义(P>0.05);第三产程末和产后42 d,SA组、S组产妇Glu水平均较镇痛前即刻降低(P<0.05~P<0.01),且2组产妇血清Glu水平均低于C组(P<0.05~P<0.01),SA组亦均明显低于S组(P<0.01)。3组产妇Bromage运动评分均为0级,无一例发生运动神经阻滞。结论:针刺穴位联合硬膜外分娩镇痛可以降低PPD的发生率,其机制可能与血清Glu含量的降低及分娩疼痛减轻有关。Objective:To explore the effects of the acupuncture at acupoint combined with epidural labor analgesia on the postpartum depression(PPD)and its mechanism.Methods:One hundred and eighty full-term single primiparas were randomly divided into the acupuncture at acupoint combined with epidural labor analgesia group(group SA)and epidural labor analgesia group(group S),and the parturients without labor analgesia requirements were set as the control group(group C)(60 cases in each group).The group SA was treated with acupuncture at Sanyinjiao point and Hegu point combined with 0.5μg/mL sufentanil and 0.08%ropivacaine for epidural labor analgesia.The group S was treated with 0.5μg/mL sufentanil combined with 0.08%ropivacaine for epidural labor analgesia.The group C was not treated with labor analgesia,and the cases were treated with the routine process of natural labor.The visual pain analogue scores(VAS)in three groups were recorded when the uterine orifice was opened for 2 cm(T_(0)),the uterine orifice was fully opened(T_(1)),and the fetus was delivered(T_(2)).The serum levels of glutamate(Glu)in three groups were measured by double-antibody sandwich ELISA method immediately before analgesia,at the end of the third stage of labor and postpartum 42 days,and the edinburgh postpartum depression scale(EPDS)scores were evaluated at postpartum 42 days.The incidence rates of PPD were compared among the three groups.The analgesic pump and adverse reactions in three groups were recorded at T_(0)-T_(2).The labor course,postpartum 2 h blood loss and Bromage motion score after analgesia were recorded.Results:There was no statistical significance in the VAS score among three groups at T_(0)(P>0.05).At T_(1) and T_(2),the VAS scores in group SA and group S were significantly lower than that in group C(P<0.01),and which in group SA was also significantly lower than that in group S(P<0.01).There was no statistical significance in the blood loss among three groups in the first and second stage of labor and at postpartum 2 h(P>0.05).T

关 键 词：产后抑郁症 分娩 镇痛 针刺 穴位 谷氨酸 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R714.3[医药卫生—临床医学]