The Effect Of Transcutaneous Electrical Acupoint Stimulation On Lactation And Maternal Comfort After Cesarean Section

Objective: To investigate the effect of transcutaneous electrical acupoint stimulation(TEAS)on patient comfort and lactation after cesarean section.Methods: Ninety women were selected for cesarean section,single term pregnancy,gestational age 37～41 weeks,weight 50～90kg,age 18～35 years old,ASA grade I～II.All the parturient women in the three groups were punctured at the interval L2～3 and subjected to combined lumbar and epidural anesthesia.According to the different analgesia and treatment methods,the parturient women were divided into 3 groups by random number table method(n=30):Postoperative analgesia was performed by simple incision infiltration(Sham group)and epidural controlled analgesia(Sufentanil 50ug+ ropivacaine150mg+0.9% normal saline to 150 ml,background infusion rate of 5 m L /h,PCA dose of 3m L,locking time of 15 min).(PCEA group),postoperative analgesia was treated by electric stimulation at percutaneous point + simple incision infiltration(The stimulation frequency was 2/100 Hz,the density wave and the stimulation duration was 30min)(TEAS group).After entering the subarachnoid space with lumbar anesthesia needle,the cerebrospinal fluid was confirmed to flow smoothly.According to the height and weight of parturient,the parturient was given a mixture of 0.75% ropivacaine injection 10～15 mg and 50% glucose solution 0.1～0.2ml,which was mixed with the cerebrospinal fluid and diluted to 3ml.The local anesthetic was injected into the subarachnoid space at a rate of about 0.1 m L/s,and the anesthesia level was adjusted to T6 level.The reduction in blood pressure maintained with norepinephrine was no more than 20% of the baseline value.Atropine was used to maintain the stability of the center rate of obstetrics and gynecology.Postoperative analgesic effect evaluation: Postoperative visual analogue scale(VAS)was used to record the pain situation and postoperative analgesic recovery rate from1 to 3 days after childbirth and obstetrics.Evaluation of postoperative lactation effect: the beginning time of lactation after obstetrics and Gynecology was recorded,the lactation sufficiency rate 1 to 2 days after surgery was evaluated,and the serum prolactin content before and 1 to 3 days after surgery,and the serum dopamine content before and 1～3d after surgery were evaluated.Postoperative recovery: the incidence of nausea and vomiting and the time of first anal exhaust were recorded 1～3d after childbirth and obstetrics.Qo R-40scale(including physical comfort,emotional state,psychological support,pain and self～care,a total of 40 questions,a total of 200 points)was used to score the recovery quality of patients 1～3d after surgery.Results:1.Comparison of postoperative analgesia in each group: VAS pain score within3 d after surgery showed that compared with Sham group,VAS score in TEAS group and PCEA group was lower than Sham group(P< 0.05).Compared with PCEA group,VAS score in TEAS group was higher than that in PCEA group(P<0.05),but the postoperative VAS scores of both were lower than 3;Compared with Sham group,postoperative analgesia recovery rate in PCEA group and TEAS group was lower than that in Sham group(P<0.05),there was no significant difference in postoperative analgesia recovery rate in TEAS group compared with PCEA group(P> 0.05).2.Comparison of colostrum initiation time and milk yield in each group after childbirth and obstetrics: compared with Sham group,the initiation time of colostrum in PCEA group and TEAS group was significantly shorter and milk yield was more sufficient(P<0.05);Compared with PCEA group,TEAS group had shorter colostrum initiation time and more abundant milk production(P>0.05).3.Comparison of prolactin content and dopamine content at different time points after childbirth and obstetrics among all groups: there were no statistically significant differences in prolactin content and dopamine content among the three groups(P>0.05);Compared with Sham group,puerpera in TEAS and PCEA groups had higher prolactin content and lower dopamine content(P<0.05),However,there was no statistical significance in the dopamine content of PCEA group and Sham group at postpartum 3d(P>0.05);Compared with TEAS group,maternal prolactin content in PCEA group was reduced and dopamine content was increased(P<0.05).4.Comparison of the time of anal exhaust and the incidence of postoperative nausea and vomiting: Compared with Sham group,the time of first anal exhaust in PCEA group and TEAS group was significantly shortened,and the incidence of postoperative nausea and vomiting was significantly reduced(P<0.05);TEAS significantly shortened the time of first anal exhaust compared with PCEA group(P<0.05),postoperative nausea and vomiting were lower than those in TEAS group(P<0.05).5.Compared with Sham group,the total score of QOR-40 scale increased in PCEA and TEAS groups from 1 to 3 days after surgery(P< 0.05);Compared with the PCEA group,the total score of QOR-40 scale increased in the TEAS group from 1to 3 days after surgery,but there was no statistical difference between the two groups(P>0.05).Conclusion: TEAS is a good choice for cesarean section patients,which can improve the patient comfort and promote the lactation function.There is a bright prospect for TEAS clinical application.