电针晚孕大鼠促分娩作用的时效性研究及机理探讨

【作者】 马良宵；

【导师】 朱江；

【作者基本信息】 北京中医药大学 ， 针灸学， 2003， 硕士

【摘要】 鉴于过期妊娠、难产、高危妊娠等病症仍是目前严重威胁母婴安全的重要因素，积极采取促分娩措施以保证分娩顺利进行和母婴安全显得十分重要。促分娩包括引产和催产两方面。临床常用的药物治疗、机械性治疗、剖宫产等几类方法都存在着或多或少的禁忌证和副作用。因此，寻求更多方便、安全、有效的促分娩方法始终是产科努力的目标之一，加强此方面的研究也有着重要的意义。 针灸下胎在我国由来已久，是历代催生助产的重要手段。许多临床资料表明，针刺具有促进宫缩、扩张宫颈、缩短产程、减少出血、减轻疼痛等作用。合谷、三阴交是使用频率最高的经典下胎对穴。而很多经典古籍中均提到针刺堕胎时先合谷后三阴交的针刺顺序，本课题组的前期实验研究也证实二穴促分娩的机制不同，同时应用二穴反而不利于各自作用的发挥，因而建议临床采用先合谷后三阴交的顺序。在此基础上，本实验试图通过对比二穴之间不同的间隔时间及留针时间对子宫收缩及内分泌的影响，来寻求获得最佳促分娩效应的刺激时间，并探讨时间因素影响二穴促分娩效果的机理，为临床合理用穴提供科学依据。 本实验以健康成年雌性Wistar大鼠为研究对象，以电针为刺激手段，采用2(2析因实验方法，其中A因素为合谷与三阴交穴的间隔时间，分为20分钟、40分钟两水平；B因素为加针三阴交后二穴的留针时间，分为5分钟、20分钟两水平。将60只实验动物随机分成电针A、B、C、D组（A组先针合谷20min，加针三阴交5min；B组先针合谷20min，加针三阴交20min；C组先针合谷40min，加针三阴交5min；D组先针合谷40min，加针三阴交20min），以及正常对照组和妊娠对照组，测定了子宫收缩强度、频率及收缩力，血清PGE2、E2、P及E2/P值，结果发现： 1．起针后20min内，A、B两因素对子宫收缩强度的影响无显著差别，而B因素对子宫收缩频率及子宫收缩力的影响较A因素更为重要，其中加针三阴交5min水平组（A、C组）显著高于20min水平组（B、D组），说明无论合谷留针时间长短，加针三阴交后5min即起针的组合方法，增强子宫收缩的效果更好，并且其增强子宫收缩力的作用主要是通过增强宫缩频率而实现的。2．A、C组在针刺合谷的基础上，加针三阴交穴5min后，其宫缩频率及宫缩力迅速升高，进一步促进了合谷留针期间已经增强的子宫收缩，显示出针刺的即时效应；同时这种促进宫缩的作用一直持续到起针后20min，也显示出了针刺的后效应，提示A、C组的组合方法协同发挥了二穴促分娩的作用，其中A组针刺方法增强宫缩的效果最佳。而B、D组在针刺过程中及起针后20min内，除增强宫缩<WP=4>频率外，对宫缩强度及宫缩力的影响不大，提示此两种方法使二穴兴奋子宫的作用产生拮抗。3．A因素对血清PGE2影响不大，而B因素中加针三阴交穴后留针5分钟较20分钟能使PGE2显著升高。A因素中合谷留针40分钟较20分钟使血清P降低越多，而三阴交留针时间长短（B因素）对P含量影响不大。A、B两因素对血清E2的影响均无显著意义，只是B因素中5min水平较20min水平有使血清E2/P值升高的趋势。进一步将四个电针组的E2/P值与妊对组和正常组比较，显示加针三阴交穴5min组（A、C组）使血清E2升高，血清P呈下降趋势，从而使E2/P升高，与未孕时相比已无明显差异，同时还增加了血清PGE2的含量，从而引起子宫收缩加强；而B、D组的E2/P值与妊对组无差别，且显著低于正常组；提示A、C组通过内分泌机制促进宫缩，而B、D组中加针三阴交穴后留针时间过长反而抑制了合谷穴对相关内分泌激素的调节作用。根据以上分析，得出结论：针刺采用先合谷后三阴交穴的顺序，能不同程度地增强子宫收缩，其促分娩效果与二穴的针刺间隔时间及加针三阴交后二穴的留针时间密切相关；其中留针时间对促分娩的影响更为重要，留针5min水平较20min水平促分娩效果更佳，是基于其协同发挥了二穴在神经、体液两方面的调节作用实现的；而留针20min则使二穴的不同调节作用产生拮抗，不利于协同促分娩。因此认为临床应用合谷、三阴交穴促分娩，取穴应分先后，即先合谷后三阴交，证实了古医籍中的有关记载。同时合谷留针20min为宜，加针三阴交后，不宜长留针，可施行针刺手法得气后即起针，即能达到最佳的促分娩效果。更多还原

【Abstract】 As the diseases of prolonged pregnancy, difficult labor and high risk pregnancy were still the main factors affected security of mother and baby at the present, promoting labor has become very important to guarantee the smooth conduction of delivery and improve the puerperal security. Promoting labor includes two aspects of inducing labor and hastening labor. The common methods of promoting labor in the clinic are pharmacotherapy, mechanotherapy, cesarean section and so on, which always has contraindications or induce some side-effect. Therefore, seeking more safe, convenient and effective methods for promoting labor is an urgent task of obstetrics. Enhancing the research in this aspect also has important significance.It has been a long history in China to promote labor with acupuncture. Clinical studies indicate that acupuncture can strengthen the uterine contraction, ripen the cervix, shorten the process of labor, reduce the postpartum hemorrhage, relieve pain during labor, etc. Hegu (LI4) and Sanyinjiao (SP6) is a classical pair points for promoting labor with highest usage frequency. It was mentioned that needling LI4 firstly then SP6 afterward in promoting labor in a lot of medical classics and the early experimental research. It was also verified that using LI4 and SP6 at the same time caused antagonism. Therefore, based on the above needling order of those two points, this experiments aimed at seeking the best stimulating duration on points for promoting labor through comparing the influence on uterine contraction and endocrine system caused by different interval between LI4 and SP6 and different duration of retention needles in those two points, in order to provide scientific evidence for using points in the clinic. And the mechanism of influence on promoting labor by time factors was also the aim the experiment.Healthy grown-up female Wistar rats were the study objects, while electric acupuncture was the stimulate method. Factorial experiment with 2 factors and 2 levels was applied. Factor A was the interval between LI4 and Sp6, including 2 levels of 20min and 40min. Factor B was the duration of retention needles in those two points after needling SP6, also including 2 levels of 5min and 20min. Sixty rats were randomly divided into 6 groups: electric acupuncture group A, B, C and D (A group: needling LI4 20min firstly, then SP6 5min; B group: needling LI4 20min firstly, then<WP=6>SP6 20min; C group: needling LI4 40min firstly, then SP6 5min; D group: needling LI4 40min firstly, then SP6 20min), normal control group and pregnant control group. The values of intensity, frequency and potency of uterine contraction and the contents of serum PGE2, E2, P and ratio of E2 and P were measured. The results were as follows: 1.In 20min after removing needles, there was no significant difference of intensity of uterine contraction caused by factor A and B, while significant difference of uterine contraction frequency was found, factor B was more important than factor A. The frequency in groups with retention needles for 5min after needling SP6 was significantly higher than those in groups with 20min level. It suggested the method of retention needles for 5min after needling SP6 regardless of duration of needling LI4 had better effect of strengthening uterine contraction, which was obtained mainly through increasing the frequency of uterine contraction.2.In group A and C, the frequency and potency of uterine contraction were in creased significantly in 5min when SP6 was needled. Then the increased uterine contraction caused by needling LI4 was promoted by SP6, showing the instant effect of acupuncture. And this effect also remained for 20min after the removal of needles, showing the lasting effect of acupuncture. It was suggested that the needling methods in group A and C made the coordinated function of LI4 and SP6 in promoting labor. While the method in A group was the best needling method to increase uterine contraction. There was no significant change in intensity and potency of uterine contrac更多还原