Abstract:

Objective　To explore the effect of transcutaneous acupoint electrical stimulation combined with epidural labor analgesia in promoting vaginal delivery after cesarean section and preventing postpartum depression. Methods　A total of 120 women who took vaginal delivery after cesarean section and underwent prenatal examination and delivery in Guangdong Women and Children's Hospital from October 2021 to October 2022 and required labor analgesia were selected and divided into a control group and an observation group by the random number table method, with 60 cases in each group. The control group were 32 (30, 34) years old, with a gestational age of (39.48±0.88) weeks; they took epidural labor analgesia. The observation group were 33 (31, 34) years old, with a gestational age of (39.48±0.68) weeks; they took percutaneous electrical acupoint stimulation and epidural labor analgesia. The scores of Visual Analogue Scale (VAS) at the time of labor, before and 1 h after the implementation of labor analgesia, at the time of uterine opening, and 1 h after the end of labor, the times of labor, and the maternal and infant outcomes were compared between the two groups. The Edinburgh Postpartum Depression Scale (EPDS) was used for screening postpartum depression 42 days and 6 months after delivery. The independent sample t test, nonparametric test, χ² test, and analysis of variance of repeated measurement were used. Results　The scores of VAS before and 1 h after the implementation of labor analgesia, at the time of uterine opening, and 1 h after the end of labor in the observation group were (6.13±0.70), 1(0,1), (1.47±0.77), and 0(0,1), which were lower than those in the control group [(8.32±0.87), 3(3,4), (4.03±0.80), and 1(0,1)], with statistical differences between the two groups (F_groups=528.457, P<0.001). The first stage of labor in the observation group was shorter than that in the control group [4.70 (3.55, 6.80) h vs. 6.10 (4.30, 7.45) h], with a statistical difference (Z=-2.150, P=0.032). The scores of EPDS 42 days and 6 months after delivery in the observation group were lower than those in the control group [6.00 (5.00, 8.00) vs. 7.00 (6.00, 12.75) and 3.00 (2.00, 4.75) vs. 5.00 (4.00, 8.00)], with statistical differences (Z=-2.488 and -5.406, P=0.013 and <0.001). Conclusion　Transcutaneous acupoint electrical stimulation combined with epidural labor analgesia can reduce the risk of postpartum depression in women taking vaginal delivery after cesarean section, alleviate their labor pain, promote their labor progresses, and facilitate natural delivery.

Key words:

Depression, Postpartum, Scarred uterus, Transcutaneous acupoint electrical stimulation, Epidural labor analgesia, Maternal and infant outcomes

摘要：

目的　探讨经皮穴位电刺激联合硬膜外分娩镇痛在促进剖宫产后再次妊娠产妇阴道分娩及预防产后抑郁的作用。方法　选取2021年10月至2022年10月在广东省妇幼保健院产检和分娩的且有分娩镇痛要求的剖宫产后再次妊娠阴道分娩产妇120例，以随机数字表法分为两组，对照组60例，年龄32（30，34）岁，孕周（39.48±0.88）周，采用硬膜外分娩镇痛。观察组60例，年龄33（31，34）岁，孕周（39.48±0.68）周，采用经皮穴位电刺激联合硬膜外分娩镇痛。比较两组产妇临产时、分娩镇痛实施前、实施后1 h、宫口开全和分娩结束后1 h疼痛视觉模拟量表（VAS）评分、产程时间及母婴结局指标；并于产后42 d和产后6个月采用爱丁堡产后抑郁量表（EPDS）进行产后抑郁的筛查。采用独立样本t检验、非参数检验、χ²检验及重复测量的方差分析进行统计比较。结果　观察组分娩镇痛实施前、实施后1 h、宫口开全和分娩结束后1 h的VAS评分分别为（6.13±0.70）分、1（0，1）分、（1.47±0.77）分、0（0，1）分，均低于同期对照组［（8.32±0.87）分、3（3，4）分、（4.03±0.80）分、1（0，1）分］，两组不同时间节点比较差异有统计学意义（F_组间=528.457，P<0.001）。观察组第一产程时间为4.70（3.55，6.80）h，短于同期对照组6.10（4.30，7.45）h，两组比较差异有统计学意义（Z=-2.150，P=0.032）。观察组产后42 d及产后6个月EPDS评分分别为6.00（5.00，8.00）分、3.00（2.00，4.75）分，均低于对照组［7.00（6.00，12.75）分、5.00（4.00，8.00）分］，差异均有统计学意义（Z=-2.488、-5.406，P=0.013、<0.001）。两组产妇产后出血量及新生儿Apgar评分比较，差异均无统计学意义（均P>0.05）。结论　经皮穴位电刺激联合硬膜外分娩镇痛可降低剖宫产后再次妊娠阴道分娩产妇发生产后抑郁的风险，减轻分娩疼痛，促进产程，利于自然分娩。

关键词:

抑郁症, 产后, 瘢痕子宫, 经皮穴位电刺激, 硬膜外分娩镇痛, 母婴结局