| ObjectivesTo evaluate the feasibility of electroacupuncture combined with intraspinal anesthesia and select the superior effect method for labor analgesia,via randomized controlled clinical trials based on the objective evaluation of the three labor analgesia methods’ clinical efficacy.To explore the mechanism of labor analgesia through the detection of a number of experimental indicators.MethodsA total of 180 parturients eligible for the study were randomly divided into three groups with 60 cases in each group,namely,electroacupuncture combined with intraspinal anesthesia group(group 1),intraspinal anesthesia group(group 2)and electroacupuncture group(group 3).The parturients in group 1 were performed acupuncture after successful intraspinal anesthesia.HANS-200A acupoint nerve stimulator was connected to the acupoints after acupuncture at Hegu,Neiguan,Zusanli and Sanyinjiao.Ipsilateral Hegu-Neiguan was connected as a loop and was stimulated for 20 min,which was followed by the stimulation of ipsilateral Zusanli-Sanyinjiao for 5min.The electroacupuncture parameter was set as 2Hz/50Hz frequency,dilatational wave,0.1～1.0mA current intensity.This electroacupuncture operation was repeated every 2h if it was still in first stage in labor.The parturients in group 2 and 3 were treated with intraspinal anesthesia and electroacupuncture respectively.All the parturients conducted Lamaze breathing under the guidance of the midwife in the whole delivery process,and received routine obstetric care.The major outcome indicators included VAS score at 9 time points(immediatly before analgesia,100min,30min,60min,120min after analgesia,the time of 10cm cervical dilation,end of second and third stages,24h after delivery),and side effects(urinary retention,fever,and pruritus)after analgesia.The secondary outcome indicators included the time of labor analgesia,second and third stages,the rate of oxytocin use,instrument midwifery and caesarean section,the amount of blood loss during and 24h after delivery,the Apgar score at 1 min,5 min and 10 min,and the neonatal cord blood gas analysis(pH,PO2,PCO2,HCO3-,BB,BE,Lac).The laboratory indicators included the contents of β-EP,DYN,5-HT,TNF-a,NGF and PGE2 in maternal peripheral blood and the expression of TRPV1 protein in placental tissue.ResultsA total of 180 cases were included in the study,10 cases were excluded,4 cases were shed,and 166 cases were completed.1.Baseline analysisThe compared baseline of Sociodemographic basic characteristics’indicators(age,height,weight,BMI before pregnancy,weight before delivery)and clinical features’ indicators(gestational age,history of miscarriage,fundal height,CPT score,premature rupture of membranes,blood pressure,heart rate,fetal heart rate)of all the parturients were consistent with good comparability(P>0.05).2.Major outcome indicators(1)Pain score:① There was no statistically significant difference in labor pain VAS score of immediatly before analgesia among the three groups(P>0.05),which was comparable.②The VAS scores after analgesia of the three groups were lower than those before analgesia(P<0.05).③ There was statistically significant difference in VAS scores between the three groups at each time point after analgesia(P<0.05),and the VAS score from low to high was group 1<group 2<group 3.(2)Side effects after analgesia:① There was statistically significant difference in the incidence of urinary retention between the three groups(P<0.05),with group 1 and 3<group 2(P<0.0125).② There was statistically significant difference in the fever rate among the three groups(P<0.05),and group 3<group 1<group 2(P(0.0125).③ There was no significant difference in the incidence of pruritus between the three groups(P>0.05).3.Secondary outcome indicators:(1)Stages of labor:① There was statistically significant difference in the active stage between the three groups(P<0.05),and group 3<group 1<group 2(P<0.008).② There was statistically significant difference in the second stage between the three groups(P<0.05),and group 3<group 1 and 2(P<0.008).③ There was no significant difference in the third stage between the three groups(P>0.05).(2)There was statistically significant difference in the rate of oxytocin use between the three groups(P<0.05),with group 1 and 3<group 2(P<0.0125).(3)There was no significant difference in the rate of instruments midwifery between the three groups(P>0.05).(4)There was statistically significant difference in the rate of cesarean section between the three groups(P<0.05),and group 3<group 2(P<0.0125).(5)Postpartum blood loss:① There was statistically significant difference in the amount of blood loss during delivery between the three groups(P<0.05),and group 3<group 2(P<0.008).② There was statistically significant difference between the three groups in the amount of blood loss 24h after delivery(P<0.05),and group 3<group 2(P<0.008).(6)There was no significant difference in Apgar scores between the three groups at lmin,5min and 10min(P>0.05).(7)There was no significant difference between the three groups in the results of umbilical cord blood gas analysis(P>0.05).4.Compliance and safety assessment(1)There was no significant difference in compliance between the three groups(P>0.05).(2)There was no significant difference in safety between the three groups(P>0.05).5.Laboratory indicators(1)Contents of β-EP,DYN,5-HT,TNF-a,NGF and PGE2 in peripheral blood:① Immediately before analgesia,there was no significant difference in the contents of six substances in maternal peripheral blood between the three groups(P>0.05).② At the time of 10cm cervical dilation,the contents of six substances in the peripheral blood of the three groups were all higher than those before analgesia,and the difference was statistically significant(P<0.05).③ At the time of 10cm cervical dilation,there was statistically significant difference in the contents of six substances between the groups(P<0.05),in which,the content of β-EP,DYN were group 1>group 2>group 3,the content of 5-HT,TNF-α,NGF,PGE2 were group 1<group 2<group 3.(2)There was statistically significant difference between the three groups in the relative gray value of TRPV1 protein in the placental tissues(P<0.05),and group 1<group 2<group 3.Gonclusions1.All of the three methods could relieve labor pain.Electroacupuncture combined with intraspinal anesthesia showed the best analgesic effect from the beginning of analgesia to 24h after delivery.There was synergy between electroacupuncture and intraspinal anesthesia,which could enhance the analgesic effect.2.The urinary retention and fever incidence of electroacupuncture were lower than those of intraspinal analgesia.The combination of electroacupuncture with intraspinal anesthesia could reduce the incidence of urinary retention and fever compared with intraspinal anesthesia.3.The active stage and second stage of electroacupuncture were shorter than those of other two methods.The combination of electroacupuncture with intraspinal anesthesia could shorten the active stage compared with the intraspinal anesthesia.4.The oxytocin use of electroacupuncture were less than that of intraspinal anesthesia.The combination of electroacupuncture with intraspinal anesthesia could reduce the use of oxytocin compared with intraspinal anesthesia.5.Electroacupuncture could reduce the cesarean section rate compared with intraspinal anesthesia.6.Electroacupuncture could reduce the amount of postpartum blood loss compared with intraspinal anesthesia.7.There was no significant difference in the affect of the three methods on the incidence of pruritus,the third stage,the rate of instruments midwifery,and the risk of fetal hypoxia and asphyxia.8.All the three methods could increase the contents of p-EP and DYN,reduce the contents of 5-HT,NGF,TNF-α and PGE2 in peripheral blood,and reduce the expression of TRPV1 in placental tissue.There was synergy between electroacupuncture and intraspinal anesthesia,which could enhance the effect. |
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