| In the middle of 20 century, the cesarean section rate of China is only 5%, while recently the rate is increasing year on year. The World Health Organization reported that the cesarean section rate of China was 46.2%, ranking the first among Asian countries. According to preliminary research, the cesarean section rate in some big city is 40%~60%, even 80% in a small number of hospitals.Applying combined spinal epidural anesthesia(CSEA) in cesarean section could rapidly reduce the pain caused by uterine contraction and deal with the fetal intrauterine distress in a short period of time. This technology is very mature, but the hypotension—the most common complication of combined spinal epidural anesthesia is still unavoidable with an occurrence rate of 30%~60%.This would cause nausea and vomiting and dizziness when hypotension comes up. It would also cause placental abruption, circulatory disturbance and cardiovascular disease in some severe cases. The fall of blood pressure of mother would reduce the placental blood flow volume, leading to fetal distress and asphyxia of newborn.The therapy of hypotension includes changing body position and venous blood volume dilatation. However, these physical therapies not only increase cardiac load, but also have an unapparent curative effect. In addition, we also need drugs to keep blood pressure. As for ephedrine- the common drug that is applied, it has weak effect on placenta vasoconstriction but it would cause the puerperal tachycardia or fetus blood p H dropping down.Acupuncture is the gem of our country, with advantages of wide indication, convenient usage, safety and low cost. It is accepted world wild. According to the theory of traditional Chinese medicine, we could treat patients by acupuncture points stimulation, which can improve the flow in main and collateral channels. A large number of studies confirm that acupuncture has the "two-way" adjustment function on blood pressure. However, the mechanism of acupuncture is not clear after decades of research. Meanwhile, the recent study also shows that, transcutaneous electrical acupoint stimulation(TEAS) of Neiguan has a role of regulation vascular pressure and cardiovascular sympathetic system. This study concentrated on hypotension and related adverse reactions of clinical cesarean patients after spinal anesthesia. We have observed whether TEAS can improve the hypotension induced by combined spinal epidural anesthesia in patients with cesarean section. Finally, we found that stimulation at Neiguan point by high frequency dilatational wave can effectively improve hypotension, which is probably related with the increased norepinephrine levels and following sympathetic excitability change caused by TEAS..Experiment I. The effect of TEAS with different frequency on hypotension after hypotension after spinal anaesthesia in patients undergoing Caesarean sectionObjective:To observe whether TEAS with Low Frequency disperse-dense wave or High Frequency disperse-dense wave on Neiguan and Zusanli can prevent the hypotension caused by CSEA in cesarean section of delivery womenMethod:120 healthy parturients were randomly divided into 4 groups with 30 in each group: the low frequency dilatational wave(2/10Hz) TEAS stimulation of Neiguan + Zusanli group(LF PC6+ST36 group), high frequency dilatational wave(10/50Hz) TEAS stimulation of Neiguan + Zusanli group(HF PC6+ST36 group), control group, non acupoint stimulation group(Sham group). Intravenous channel were established for the subjects after they entered the delivery room. Then the subjects received Sodium Lactate Ringer’s Injection(10ml/kg) within 15 minutes by taking the siting position. Blood pressure and heart rate were recorded for three times respectively. Average of the three was regarded as comparison value. Then the subjects received standard CSEA, which was required with right lateral position. Local anesthesia solution for spinal anesthesia was 0.75% bupivacaine1.4ml and 50% glucose0.2ml. The injection duration was 15 seconds with anesthesia level below T6-T8.The subjects took horizontal position after the CSEA with operation table leaning left with 20°. Within the following 30 minutes after the completion of CSEA, blood pressure were taken and recorded every 2 minutes. When hypotension happened during this process, the subject would be given 10 mg ephedrine immediately via vein. 2 minutes later, ifhypotension continued, another 10 mg ephedrine would be given to the subject until the blood pressure came back to the normal value. In this research, bradycardia was defined as heat rate less than 50 times per minute, which would be treated with 0.3mg atropine. Symptoms like Nausea and vomiting, choking sensation in chest, expiratory dyspnea and dizziness and dosage of ephedrine were recorded.Result:There is no statistical difference of general data between each group.Compared with Control group, the incidence of hypotension, nausea, vomiting, and chest tightness had decreased significantly in HF PC6+ST36 group(P<0.05). And the incidence of hypotension, nausea, vomiting, and chest tightness in Sham group, LF PC6+ST36 group had no statistical difference.Compared with Control group, the ephedrine dosage and nausea and vomiting scores were significantly decreased in HF PC6+ST36 group, while the satisfaction scores increased significantly in HF PC6+ST36 group(P<0.05). And the ephedrine dosage, nausea and vomiting scores and satisfaction scores in Sham group, LF PC6+ST36 group had no statistical difference.Experiment II. The effect of preventing hypotension caused by CSEA in patients undergoing Caesarean section with High frequency disper-dense wave TEAS on Neiguan or Zusanli or Neiguan and ZusanliObjective:To observe with High Frequency disperse-dense wave TEAS whether on Neiguan or Zusanli or Neiguan and Zusanli can prevent the hypotension caused by CSEA in cesarean section of delivery women.Method:120 delivery women who would receive Caesarean section were randomized divided into four groups(n=30) with SPSS software: high frequency disperse-dense waveTEAS stimulating Neiguan group(HF PC6 group),high frequency disperse-dense wave TEAS stimulating Zusanli group(HF ST36 group), high frequency disperse-dense wave TEAS stimulating Neiguan and Zusanli group(HF PC6+ST36) and control group(Control group). The appearance of blood pressure, heart rate, nausea and vomiting, choking sensation in chest, dyspnea, dizzy and the dosage of ephedrine were recorded.Result:There is no statistical difference of general data between each group.Compared with Control group and HF ST36 group, the incidence of hypotension, chest tightness and dyspnea had decreased significantly in HF PC6+ST36 and HF PC6 group, and the incidence of nausea and vomiting had decreased significantly only in HF PC6+ST36 group. There is no statistical difference of above mentioned symptom data between Control group and HF ST36 group. Compared with HF PC6 group, the incidence of chest tightness, nausea and vomiting had decreased significantly in HF PC6+ST36 group, and the incidence of hypotension and dyspnea had no statistical difference.Compared with Control group and HF ST36 group, the ephedrine dosage were significantly decreased in HF PC6+ST36 and HF PC6 group, nausea and vomiting scores were significantly decreased while the satisfaction scores increased significantly only in HF PC6+ST36 group. There is no statistical difference of above mentioned data between Control group and HF ST36 group. Compared with HF PC6 group, nausea and vomiting scores were significantly decreased in HF PC6+ST36 group, and the ephedrine dosage and satisfaction scores had no statistical difference.Experiment Ⅲ.The mechanism of preventing hypotension caused by CSEA in patients undergoing Caesarean section with TEASObjective:To identify the relation between the effect of preventing hypotension caused byCSEA in patients undergoing Caesarean section with TEAS and the content of epinephrine and norepinephrine level.Method:150 healthy delivery women were chosen as subjects. 2ml blood was taken after intravenous channel was established. Another 2ml blood would be taken at 30 minutes after injecting medicine in subarachnoid space. The blood sample was put into separation gel tube with coagulation factor and kept in fridge at the temperature of 4℃ for 20 minutes. After centrifugation, the serum would be taken and kept in fridge at the temperature of-80℃. The content of epinephrine and norepinephrine was tested with enzyme linked immunosorbent assay(ELISA) in several patches.Result:There is no statistical difference of the epinephrine level between 30 min after subarachnoid injection and establish vein channel in each group. And, there is no statistical difference of the norepinephrine level between Control group, Sham group and the LF PC6+ST36 group 30 min after subarachnoid injection. However, the norepinephrine level of HF PC6+ST36 group and HF PC6 group 30 min after subarachnoid injection is significantly higher than the establishment of venous channel.Conclusion1. TEAS with High Frequency disperse-dense wave on Neiguan and Zusanli could effectively prevent hypotension caused by CSEA in cesarean section of delivery women while TEAS with Low Frequency disperse-dense wave on Neiguan and Zusanli could not.2. TEAS with High Frequency disperse-dense wave on Neiguan and Zusanli or on Neiguan only could effectively prevent hypotension caused by CSEA in cesarean section of delivery women. And TEAS with High Frequency disperse-dense wave on Neiguan and Zusanli can prevent hypotension caused by CSEA in cesarean section of delivery women more effeceively than TEAS with High Frequency disperse-dense wave on Neiguan only.3. TEAS with High Frequency disperse-dense wave on Neiguan and Zusanli or TEASwith High Frequency disperse-dense wave on Neiguan can prevent hypotension caused by CSEA in cesarean section of delivery women by boosting the release of norepinephrine.SummaryIn recent years, the cesarean section rate increased year by year in China. It is a mature technology of combined spinal epidural anesthesia in cesarean section, but its adverse reactions and hypotension are common. The preventive effect of present treatment methods is inexact, and therapeutic drugs always have certain side effects, which may lead to serious adverse consequences. In this study, healthy pregnant women were taken as research object. With a control study based on random grouping, it was proved that TEAS on acupoint can reduce the incidence and degree of hypotension under intrathecal anesthesia. And better effect will get for stimulating Neiguan and Zusanli. The mechanism of TEAS is probably the increase of norepinephrine, which can raise sympathetic excitability. The results of this study will enrich the perioperative organ protection strategy, and provide scientific basis for the clinical application of TEAS technology. |
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