针药结合分娩镇痛的临床研究

目的：应用韩氏神经电刺激镇痛仪（HANS），伍用安定、曲马多，观察对分娩疼痛的缓解效果和对母婴的影响,探讨有效、简便、可推广的分娩镇痛方法。方法：270例足月、单胎、正常初产妇在宫口开大2－3cm时行胎心监护正常后，随机分为六组：HANS＋安定（10mg iv)、HANS、安定（10mgiv)、HANS＋曲马多（100mg im)、曲马多（100mg im)和对照组。将HANS两对电极片分别对称贴于夹脊穴和次髓穴，频率2／100Hz交替,呈双相对称波型，强度14－30mA。采用目测模拟（VAS）疼痛评分法，疼痛程度分4级，分别在镇痛前、镇痛后1hr、I程末期及Ⅱ程进行,分娩后进行再评分，比较各组间VAS评分、产程、胎心监护、新生儿Apgar评分、脐动脉血气、产后出血等指标。结果：①HANS＋安定组镇痛有效率（有效＋显效）最高为90．3％，其次，HANS＋曲马多组为78．9％，HANS组59．8％。②两组针药结合组在镇痛后1hr、I程末期及Ⅱ程时VAS评分均较镇痛前明显降低（P＜0．01），与对照组各期相比，有非常显著的统计学差异。③两组药物组VAS只的VAS评分有明显升高。④HANS组VAS在镇痛后1hr和Ⅱ程时比镇痛前明显下降（P＜0．01），I程要有所下降（P＜0．05）。⑤各组比较，HANS＋安定组VAS在镇痛后1hr和Ⅱ程时均明显低于其余五组（P＜0．01），I程末曲马多组及HANS＋曲马多组无统计学差异，但仍显著低于其余三组（P＜0．01）。⑥各组产程长短、分娩方式、产后出血量及胎儿宫内窘迫和新生儿窒息率、脐动脉血pH值均无统计学差异。结论：分娩镇痛应用电刺激镇痛仪加少量镇静痛药物（安定或曲马多），有良好的镇痛效果，又不影响机体的生理功能,对胎儿亦无不良影响，因此，HANS伍用安定、曲马多可作为有效、安全且适合我国国情，便于推广的分娩镇痛方法。

Application of Acupuncture Combined with Medicines for Pain Relief during Labor

Objective: To evaluate the effect of combined application of HANS(Han's Acupoint Nerve Stimulator) and diazepam and tramadol on labor pain and its influence on mother, fetus and newborn baby in order to find a safe, convenient and effective method for pain relief during labor.Methods: 270 normal term pregnancy and primipara with single vertex presentation were randomly divided into six groups: HANS+diazepam(diazepam 10 mg, iv), HANS, diazepam(diazepam 10 mg, iv), HANS+tramadol(tramadol 100 mg,im), tramadol(tramadol 100 mg,im) and control group. All the methods for relieving pain were given when the cervixs were dilated to about 2～3 cm in diameter. The plate like electrodes of HANS were placed at Jiaji(EX B 2) and Ciliao(BL 32) for stimulating these points with frequency of 2/100 Hz alternately and intensity of 14～30 mA. Labor pain was evaluated by VAS(visual analogue scaling) and graded into four degrees at the time of one hour before and after analgesia, the cervix dilation being about 7～8 cm in diameter, second stage, and post labor respectively. Indexes of VAS, duration of labor, fetal cardiotocography, post partum bleeding, blood gas analysis of umbilical artery, Apgar score and asphyxia of different groups were compared.Results: ① The analgesic effective (markedly effective plus effective rate) rates of HANS+diazepam, HANS+tramadol and HANS were 90.3%,, 78.9% and 59.8% respectively. ② In the two groups of combination of HANS and medicines, the VAS at the time of one hour after analgesia, cervix dilation of 7～8 cm and second stage were significantly lower than those of pre analgesia (P<0.01). There were significant differences in VAS between each experimental group and control group in various stages. ③ In two medicine groups, the VAS at the time one hour after analgesia was much lower than that of pre analgesia (P<0.01), but at the time of cervix dilating 7～8 cm and second stage, the VAS of diazepam group was the same to that of pre analgesia, and that of tramadol was higher than that of pre analgesia. ④ In HANS group, the VAS at the time one hour after analgesia and second stage were much lower than that of pre analgesia(P<0.01), at the time of cervix dilating 7～8 cm, the VAS was lower than that of pre analgesia(P<0.05). ⑤ The VAS of HANS+diazepam at the time of one hour after analgesia and the second stage were much lower than those of the rest 5 groups. There was no statistical difference between tramadol and HANS+tramadol groups in VAS at the time of cervix dilating 7～ 8 cm, but VAS of tramadol and HANS+tramadol groups were much lower than those of the other three groups(P<0.01). ⑥ There were no significant differences among the six groups in duration of labor, delivery mode, post partum bleeding, fetal distress, neonatal asphyxia and umbilical blood PH.Conclusion: HANS combined with some sedative or analgetics (diazepam, tramadol) has good analgesic effect on labor pain. No side effect was found in mothers and babies. It is suggested that combination of HANS and diazepam or tramadol is safe, convenient and effective for relieving pain during labor.