摘要
目的:通过与硬膜外分娩镇痛比较,观察穴位注射罗哌卡因分娩镇痛对产妇产程的进展速度、产后母亲泌乳启动和母乳喂养的影响。方法:选择自愿要求分娩镇痛的初产妇80例,采用随机数字表法分为硬膜外镇痛组和穴位注射组,每组40例。于产妇宫口开至≥3cm时(即第1产程活跃期)实施分娩镇痛。硬膜外镇痛组采用硬膜外自控镇痛方式给予5μg/mL舒芬太尼和0.1%罗哌卡因;穴位注射组取双侧合谷、三阴交,每穴注入0.2%罗哌卡因1mL。选择同期拒绝行分娩镇痛的40例产妇作为对照组。记录产妇镇痛前(T0)、镇痛后30min(T1)、宫口开全时(T2)及胎头娩出时(T3)的视觉模拟量尺(VAS)评分;记录产程时间及使用缩宫素例数,并计算各组产钳助产率和剖宫产率;记录产妇产后泌乳始动时间和24h哺乳次数;检测产前及产后24h血清催乳素含量。结果:13名产妇因中转剖宫产退出试验,其中对照组4名,硬膜外镇痛组5名,穴位注射组4名,共计107名产妇完成本试验。与组内T0时或对照组比较,硬膜外镇痛组和穴位注射组T1、T2、T3的VAS评分均明显降低(P<0.05);与硬膜外镇痛组比较,穴位注射组T1、T2、T3的VAS评分显著升高(P<0.05)。与对照组比较,硬膜外镇痛组第2产程时间延长(P<0.05),应用缩宫素例数增多(P<0.05);与硬膜外镇痛组比较,穴位注射组第2产程时间缩短(P<0.05),应用缩宫素例数减少(P<0.05)。与对照组比较,硬膜外镇痛组和穴位注射组产后首次哺乳时间更早(P<0.05),24h内哺乳次数增多(P<0.05)。穴位注射组产后血清催乳素水平较对照组和硬膜外镇痛组显著升高(P<0.05)。结论:穴位注射罗哌卡因分娩镇痛效果良好,不增加缩宫素的用量,不延长第2产程,且更有益于产妇产后早期实施母乳喂养。
Objective To investigate the efficacy of acupoint injection of Ropivacaine for labor analgesia and its effect on breastfeeding and prolactin secretion.Methods A total of 80 primipara who asked to receive labor analgesia were randomized into epidural analgesia group(n=35)and acupoint injection group(n=36),and other 36 primipara who refused to receive labor analgesia were subjected to the control group.The labor analgesia began to be performed when the puerpera’s uterine orifice opened about≥3cm(the first stage of labor),including puerpera controlled epidural analgesia(PCEA,Sufentainil+ 0.1%Ropivacaine hydrochloride,5μg/mL at L3-L4 interspace,till the birth of fetus)or acupoint injection of Ropivacaine(0.2%,1mL/acupoint)at bilateral Hegu(LI4)and Sanyinjiao(SP6).The delivery situations such as the duration of labor,and number of cases who used oxytocin,obstetric-forceps-aided delivery,cesarean delivery were recorded.The serum prolactin concentration was assayed by using ELISA.The visual analogue scale(VAS)scores at the time points of T0(about 3cm widening of the orifice of uterus and before performing analgesia),T1(30 min after labor analgesia),T2(about 10 cm widening of the orifice of uterus)and T3(coming out of fetal head).The duration of labor,ratio of use of oxytocin,onset time of breastfeeding,and times of breastfeeding within 24 postpartum hours were recorded accordingly.Results The VAS scores at time-points of T1,T2 and T3 were significantly lower in both epidural analgesia and acupoint injection groups in comparison with their own T0 and the control group(P<0.05),and were also considerably higher in the acupoint injection group than in the epidural analgesia group(P<0.05).The duration of the 2 nd stage of labor(from complete opening of the uterus orifice to complete birth of the fetus)was significantly longer,(P<0.05)and the number of oxytocin-using puerpera was obviously bigger in the epidural analgesia group than in the control group(P<0.05).After partum,the 1 st breastfeeding time was obviously earlier and the frequency of breastfeeding notably increased in both epidural analgesia and acupoint injection groups than in the control group(P<0.05),the serum prolactin content was remarkably higher in the acupoint injection group than in the epidural analgesia group(P<0.05).No significant differences were found between the acupoint injection and the control groups in the duration of the 1 st and 2 nd stages of labor,and in the numbers of oxytocin-using puerpera,obstetric forceps-aided birth and cesarean delivery(P>0.05),and between the epidural analgesia group and control group in the serum prolactin levels(P>0.05).Conclusion Injection of Ropivacaine at LI4 and SP6 is effective for labor analgesia and raising prolactin level,and favorable to breastfeeding in the early postpartum period.
作者
方琴
李永乐
蔡明阳
黄薇
袁超
陈祥楠
FANG Qin;LI Yong-le;CAI Ming-yang;HUANG Wei;YUAN Chao;CHEN Xiang-nan(Department of Anesthesia, Guangdong Provincial Maternal and Child Health Hospital,Guangzhou 510010, China)
出处
《针刺研究》
CAS
CSCD
北大核心
2019年第6期434-438,共5页
Acupuncture Research
基金
广东省科技计划项目(No.2016ZC0183)
