五行音乐配合电针对分娩疼痛的镇痛效应及作用机制研究

Labor pain is one of a variety of pains which possess the highest pain threshold, while there is no satisfactory antalgic method for the treatment of labor pain so far. At present, the study of non pharmacological analgesic without trauma has been the focus. The treatment with five-element music is based on the theory of Viscera & Meridians of Traditional Chinese Medicine (TCM) and the neuroanatomy, and acupuncture, a wonderful treatment in TCM, has analgesic effect through regulating meridians and promoting the circulation of Qi and blood. The previous studies indicated that electro-acupuncture can effectively treat labor pain, and increase serum DYN level in labor women. Moreover, ERK, the upstream regulator of DYN, mediates the development of pain. Based on the theory of musicology, TCM, modern medicine, molecular biology, the study aims to observe the antalgic effects of five-element music with electro-acupuncture on the pain of labor women, and to analyze the gene and protein expression of signal molecules including Raf, ERK, CREB and the targeted molecule DYN using Real-time PCR and Western blot, which will reveal the antalgic mechanisms of five-element music with electro-acupuncture based on ERK signal pathway, offer a safe, effective, and simple treatment for labor analgesia, and provide scientific evidence and theorical basis for the treatment of labor pain using five-element music with electro-acupuncture.

分娩疼痛是世界上疼痛阈值最高的疼痛种类之一，迄今尚无满意的镇痛方法。非药物无创伤镇痛已成为现代研究的热点。 五行音乐疗法有深厚的脏腑、经脉理论基础和神经解剖学基础，而针灸又是传统中医学宝库中的一支奇葩，它有通经脉、调血气、镇痛的作用。课题组前期研究发现电针对分娩镇痛效果明显，能使孕妇血清中DYN含量增加；电针大鼠三阴交穴，可提高痛阈值。而有研究证明ERK为DYN基因和蛋白表达的上游调节物质，调控疼痛的发生。 本项目基于音乐学、中医学、现代医学及分子生物学多学科理论，观察五行音乐加电针对分娩产妇的镇痛效应，并应用Real-time PCR、Western blot技术检测信号分子Raf、ERK、CREB和效应分子DYN的基因及蛋白质表达，以期从ERK信号通路揭示其镇痛的分子生物学机制，为分娩镇痛提供一种安全有效，简单易行的方法，为应用五行音乐加电针进行分娩镇痛提供科学依据和理论基础。

分娩疼痛是世界上疼痛阈值最高的疼痛种类之一，迄今尚无满意的镇痛方法。非药物无创伤镇痛已成为现代研究的热点。本课题探讨五行音乐配合电针对分娩镇痛作用及机制。方法 对产妇在分娩过程中应用五行音乐加电针分娩镇痛，并与对照组、药物组及电针组进行对照观察产程时间，产后2小时内出血量及对新生儿的影响， Western blot、Real-time PCR检测胎盘组织C-Raf；P-ERK；P-CREB及 PDYN蛋白与基因表达；ELISA检测产妇静脉血DYN含量。结果：临床显示，五行音乐加电针组在镇痛持续时间、总产程时间、产后2小时内子宫出血量及对新生儿的影响等方面优于其他三组，组间差异有统计学意义(P<0.010)；实验显示，五行音乐加电针组，一方面可提高DYN在产妇外周血清的含量及产妇靶器官蛋白与mRNA的表达，另一方面能抑制Raf/ERK/CREB通路分子蛋白磷酸化。ERK信号分子Raf、ERK及CREB磷酸化蛋白与 mRNA在四组产妇胎盘组织表达，与对照组相比，电针组、五行音乐加电针组及药物组均显著偏低，组间差异明显有统计学意义(P<0.010),由高到低依次为对照组>电针组/五行音乐加电针组>药物组。结论：五行音乐加电针对产妇分娩疼痛具有明显的镇痛效果，可有效缩短产妇产程时间，减少产后2h内子宫出血量，提高新生儿出生后1分钟、5分钟的Apgar评分及增加新生儿血氧含量； Raf/ERK/CREB通路分子蛋白与效应分子DYN蛋白存在负相关性。揭示，五行音乐配合电针对分娩镇痛作用及ERK信号通路介导DYN释放产生镇痛机制。