经皮穴位电刺激联合超声引导下阴部神经阻滞在分娩镇痛中的临床研究

Clinical study of transcutaneous electrical acupoint stimulation combined with ultrasound-guided pudendal nerve block in labor analgesia

摘要:

目的 探讨经皮穴位电刺激（transcutaneous electrical acupoint stimulation，TEAS）联合超声引导下阴部神经阻滞对阴道分娩产妇镇痛效果及妊娠结局的影响。方法 选取2021年7月至2022年1月在重庆市妇幼保健院经阴道分娩的初产妇106例，采用随机数字表法分为2组（经皮穴位电刺激联合超声引导下阴部神经阻滞为TP组，单纯硬膜外镇痛为EP组），每组53例。观察产妇在干预前（T₀）、宫口开至6 cm（T₁）、胎头着冠时（T₂）的VAS评分，检测各时点β-内啡肽（β-endorphin，β-EP）浓度，比较2组产程时长，新生儿1 min Apgar评分、会阴情况及分娩后并发症。结果 2组产妇VAS评分自镇痛开始后均明显降低（P<0.01），且在不同时点VAS评分降低程度不一样；EP组VAS评分在T₁时低于TP组，在T₂时高于TP组（P<0.05）；与EP组相比，TP组β-内啡肽浓度在T₁、T₂时增高（P<0.05）；TP组产妇的第一产程活跃期及第二产程时间短于EP组，产妇会阴侧切率明显低于EP组（P<0.05），2组器械助产率及新生儿Apgar评分比较差异无统计学意义（P>0.05）。结论 TEAS镇痛效果在第一产程不如硬膜外阻滞明显，但TEAS联合超声引导下阴部神经阻滞可减轻全产程产痛至产妇耐受的程度，具有缩短产程及会阴保护作用，对母婴无不良影响，尤其当产妇不适用椎管内镇痛时，可作为一种安全、有效的多模式镇痛方案应用于临床。

Abstract:

Objective To investigate the effect of transcutaneous electrical acupoint stimulation（TEAS） combined with ultrasound-guided pudendal nerve block on analgesia and pregnancy outcome of pregnant women in vaginal delivery.Methods A total of 106 primiparas who delivered vaginally in our hospital from July 2021 to January 2022 were selected in the study and randomly divided into two groups with 53 cases in each group：TEAS combined with ultrasound-guided pudendal nerve block（TP group） and pure epidural analgesia（EP group）. Visual Analog Scale（VAS） scores and β-endorphin（β-EP） concentrations were observed at before intervention（T₀），uterine opening to 6.0 cm（T₁） and the fetal head crowned（T₂）. Besides，the duration of labor，1-minute Apgar score of newborns，perineum condition and complications after delivery were compared between the two groups.Results The VAS scores of the two groups of parturients were both obviously decreased since the beginning of analgesia（P<0.01），and the degree of decrease of VAS scores was different at different time points；the VAS score of TP group was higher than that of EP group at T₁，but lower than that of EP group at T₂（P<0.05）；compared with the EP group，the β-endorphin concentration of the TP group increased at T₁ and T₂（P<0.05）；the first stage of active labor and the second stage of labor time of TP group was shorter than that of EP group，and the rate of maternal perineal lateral resection of TP group was significantly lower than that of EP group（P<0.05），without statistically significant difference in the Apgar score and device-assisted rate of newborns between two groups（P>0.05）.Conclusion The analgesic effect of TEAS is not as significant as that of epidural block in the first stage of labor，while TEAS combined with ultrasound-guided pudendal nerve block can reduce labor pain in the whole process of labor to a degree，shorten the labor process and protect the perineum. And there is no adverse effect，especially when parturient are not suitable for intraspinal analgesia，it can be used as a safe and effective multimodal analgesia in clinic.