右美托咪定对穴位电刺激产妇分娩镇痛效果的影响

李莉　吕艳　翟翔隽　王冰　王建波

【摘要】 目的：探討右美托咪定对穴位电刺激产妇分娩镇痛效果的影响。方法：100例产妇随机分为右美托咪定联合穴位刺激组（A组）和穴位刺激组（B组）。A组临产后静脉输注右美托咪定，同时经皮神经电刺激合谷、三阴交和足三里穴直至胎儿娩出；B组仅经皮神经电刺激合谷、三阴交和足三里穴。记录两组产妇不同时点VAS和Ramsay评分、产程时间、产后出血量及新生儿Apgar评分，并于临产后（T0）和宫口开全时（T1）取静脉血测β-内啡肽（β-EP）、皮质醇（Cor）及促肾上腺素皮质激素（ACTH）浓度。结果：A组各时点VAS评分均明显低于B组，Ramsay评分明显高于B组，差异均有统计学意义（P<0.01）；A组第二产程时间短于B组，差异有统计学意义（P<0.01）；两组产妇T0时血β-EP、Cor及ACTH浓度比较差异无统计学意义（P>0.05）。与T0时比较，两组产妇T1时血β-EP、Cor及ACTH浓度均明显升高，A组产妇T1时β-EP浓度高于B组，Cor和ACTH浓度低于B组，差异均有统计学意义（P<0.01）。结论：右美托咪定可提高穴位电刺激产妇的分娩镇痛效果，缩短第二产程，其机制可能与β-EP含量增加及减轻应激反应有关。

【关键词】 右美托咪定； 经皮神经电刺激； 分娩镇痛

doi：10.14033/j.cnki.cfmr.2018.4.001 文献标识码 A 文章编号 1674-6805（2018）04-0001-03

Effect of Dexmedetomidine on Labor Analgesia in the Matermal with Transcutaneous Point Electric Stimulation/LI Li，LYU Yan，ZHAI Xiangjun，et al.//Chinese and Foreign Medical Research，2018，16（4）：1-3

【Abstract】 Objective：To investigate the effect of Dexmedetomidine on labor analgesia for the matermal with transcutaneous point electric stimulation.Method：A total of 100 cases were randomly divided into two groups：Dexmedetomidine combined with TENS（Group A） and TENS only（Group B）.Intravenous Dexmedetomidine combined with TENS to Hegu， Sanyinjiao， Zusanli points were given in Group A until the fetus was delivered，and TENS to Hegu，Sanyinjiao，Zusanli points only in Group B. VAS/Ramsay scores at different time，Labor time，Volume of postpartum hemorrhage and Apgar score were recorded.Blood samples were taken from both groups at the time of labor（T0） and complete cervical dilationu（T1） to test the concentrations of β-endorphin，cortisol and ACTH.Result：The VAS scores of group A at each time were significantly lower than those of group B and the Ramsay scores of group A were significantly higher than those of group B（P<0.01）.The second stage of labor in group A was shorter than that in group B （P<0.01）.There was no significant difference in the volume of postpartum hemorrhage and Apgar score between two groups（P> 0.05）.Compared with T0，the concentrations of blood β-endorphin，cortisol and ACTH in both groups significantly increased at T1（P<0.01）.The concentration of β-endorphin at T1 was significantly higher in group A than that in group B （P <0.01）. Cortisol and ACTH concentrations were lower than those in group B （P<0.01）.Conclusion：Dexmedetomidine can improve the effect of labor pain on maternals with TENS and shorten the second stage of labor.The mechanism may be associated with the increase of β-EP levels and the reduction of stress responses.

【Key words】 Dexmedetomidine； Electrical nerve stimulation； Labor analgesia

First-authors address：Tianjin Central Hospital of Gynecology & Obstetrics，Tianjin 300100，China

针刺镇痛历史悠久，效果显著。目前电针刺已广泛用于分娩镇痛，其中经皮神经电刺激（Transcuataneous electrical nerve stimulation，TENS）具有安全、有效和无创的优势[1-2]，但其存在着活跃期镇痛不足的缺点。右美托咪啶是一种高选择性α2 肾上腺素能受体激动药，具有镇静、镇痛、抑制交感神经及加快产程等优点[3]。本研究将右美托咪定联合穴位电刺激用于分娩镇痛，探讨其临床效果及作用机制，以期为临床应用提供依据。

1 资料与方法

1.1 一般资料

本研究已获医院医学伦理委员会批准，并与患者签署知情同意书。选取笔者所在医院产科2017年1-6月收治的經阴道分娩产妇100例，随机分为两组（n=50）：右美托咪定联合穴位刺激组（A组）和穴位刺激组（B组）。……