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분만 시 통증 관리를 위한 침 치료 및 경혈 지압

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Abstract

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Background

Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour.

Objectives

To examine the effects of acupuncture and acupressure for pain management in labour.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to October 2010), and CINAHL (1980 to October 2010).

Selection criteria

Published and unpublished randomised controlled trials comparing acupuncture and acupressure with placebo, no treatment or other non‐pharmacological forms of pain management in labour. We included all women whether primiparous or multiparous, and in spontaneous or induced labour.

Data collection and analysis

We performed meta‐analysis using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The outcome measures included pain intensity, satisfaction with pain relief, use of pharmacological pain relief, relaxation, caesarean section rate, augmentation with oxytocin, length of labour and anxiety.

Main results

We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention (standardised mean difference (SMD) ‐1.00, 95% confidence interval (CI) ‐1.33 to ‐0.67, one trial, 163 women). One trial increased satisfaction with pain relief compared with placebo control (RR 2.38, 95% CI 1.78 to 3.19, 150 women). Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (RR 0.72, 95% CI 0.58 to 0.88, 136 women), and compared with standard care, however, there was significant heterogeneity (RR 0.68, 95% CI 0.56 to 0.83, three trials, 704 women). Fewer instrumental deliveries from acupuncture were found compared with standard care (RR 0.67, 95% CI 0.46, 0.98, three trials, 704 women). Pain intensity was reduced in the acupressure group compared with a placebo control (SMD ‐0.55, 95% CI ‐0.92 to ‐0.19, one trial, 120 women), and a combined control (SMD ‐0.42, 95% CI ‐0.65 to ‐0.18, two trials, 322 women). No trial was assessed as being at a low risk of bias for all of the quality domains.

Authors' conclusions

Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

쉬운 말 요약

분만 시 통증을 줄이기 위한 침 치료 및 경혈 지압

침 치료 또는 경혈 지압은 분만 과정의 통증을 줄이는 데 도움이 될 수도 있지만, 이에 대해 더 많은 연구가 필요하다.

분만 통증은 매우 심할 수 있으며 산모의 긴장, 불안, 두려움이 분만 시 영향을 주어 더 심하게 느껴질 수도 있다. 많은 여성들은 통증 조절을 위한 약물이나 침습적 치료법을 사용하지 않고 출산하고 싶어하며, 통증 조절을 위한 대안적 방법을 찾는다. 13건의 임상시험 (1986명의 산모) 을 분석한 결과, 침 치료 또는 경혈 지압은 분만 통증을 줄이는 데 도움이 될 수도 있음을 발견했다. 하나 또는 몇 안 되는 수의 임상시험에서는 침 치료를 플라세보 또는 일상적 통증 관리법과 비교했을 때, 통증의 심한 정도가 줄어들었으며 통증 경감으로 인한 만족도가 증가했고 진통 약물의 사용도 줄어들었음을 보고했다. 경혈 지압 역시 통증의 강도를 줄였다. 침 치료는 몸의 각 부위에 가는 바늘 형태의 호침을 자입하여 기운의 불균형을 조정하고자 한다. 침 치료는 분만 시 개별 맞춤형 치료 (임상시험 6건) 또는 표준화된 경혈을 사용한 치료 (대부분의 임상시험) 형태로 이루어졌다. 표준화된 치료라 하더라도 자극 방법, 유침 시간, 사용한 경혈 수, 자침 깊이, 임상시험 기간 측면에서 다양한 편차가 있었다.