Vol.9, No.2, 138-151, 2003. :,,,, (S P 6), 1 ). 1..,. (Green, 1993).,,. Dick- Rea d - -(fear- t ension- pain cycle) (B ob ak, Lowdermilk & J ensen. 1995)...,. (, 2002 ; Lowdermilk, P erry & Bobak, 1999).. (,,,, 2002 ;,,, 1992 ;, 1988 ; 1987 ;,,,, 2002), (, 1999 ;,,,, 2002 ;, 2003), (, 2001 ;, 1995 ;, 2000) Doula (, 2001), (, 1998), (, 1995), (, 1988). 1) 03. 4. 15 03. 4. 19 03. 5. 20-138 -
9 2.. (acupoint acupressure) (acu point ),, (, 2003) (, 200 1). (helper ) (support er ) (, 1999). (acu point ),,,. opioid (Sh er, 1996). 30 (Chauh an, Gasser & Chauhan, 1998) (ripening),, (SP6) (Cook & Wilcox, 1997). (, 1999 ;,,,,, 2001 ;, 2002 ;, 2002)., (2002).. (2002).,.,. 2.. 3. 3cm 30,.. 1) 1:. 2) 2:. 3) 3:. 3-1 :. 3-2 : Apga r. - 139 -
2003 6 4. O3 : O5 : 60 O4 : 30 O6 : 1) ( ) 3 ( ) (, 2001 ;,, 1991 ;, 1993) ( (,, 1997). ) 3cm 30. Ext er nal t ocodynamom et er (durat ion ) 2 :3 (J imenez, 1995). 2) Spielberger (1978) 20, 4 20 80, (graphic r ating scale) 20cm 10, 0 10. 1.. (randomized cont rolled clinical t rial). R O1 O2 X1 O3 O4 O5 O6 R O1 O2 X2 O3 O4 O5 O6 <1> R : matched random assign X1 : 3 cm X2 : 3 cm O1 : O2 : 2. C,,,,. 37 42 2cm 5. (oxyt ocin )30 ( 3cm ). 3. 1) Spielberger (1978) 20, 4. 20 80. Chr onbach ' s = 0.888. (gr aphic r at ing scale). 20cm 10, 10. Spielberger Spielberger. Spielberger - 14 0 -
9 2 1 ( ) 2 ( ) ++ 3 ( ) 4 (30 ) 5 (60 ) 6 ( ) ph Apgar ++ ph Apgar <2 > (gr aphic r at ing scale) 1% (r = 0.582, p = 0.000). 2),, 30, 60. 3) Apgar., Apgar 1, 5. 4 ). 4. (1), 3cm(2), (), (3, 4, 5, 6) <2>. 1) <3>. 30. (Lowdermilk, 1999 ; Jimenez, 1995). 30 15-20 (J imenez, 1995). :. :. 2) :, : ( ) ( ) <3 > - 14 1 -
2003 6 (double- blinded meth od). 3,. (inform ed consent ) (mat ching).. 30. 30 ( 3cm ) (oxyt ocin) 3. 5. SPSS Win. 10.0 progr am. 1),,. t-t est, 2 - t est. 2) t-t est, ANCOVA, 2 - t est. 3) Chr onbach ' s. 4) Spielberger Pearson correlation coefficient.. 1. 1) < 1> (n = 36) (n = 39) n(%) ( ) n (%) ( ) t or 2 p 29.47 3.18 29.11 3.59 0.465 0.643 162.31 4.62 161.74 5.69 0.467 0.642 14.03 4.08 14.77 4.09-0.782 0.437 10(27.8) 8(20.5) 7(19.4) 19(52.8) 9(23.1) 22(56.4) 0.573 0.751 21(58.3) 15(41.7) 29(80.6) 7(19.4) 19(48.7) 20(51.3) 26(66.7) 13(33.3) 0.695 0.404 1.847 0.174 14.71 1.70 14.31 1.35 1.073 0.287 24(66.7) 12(33.3) 24(61.5) 15(38.5) 0.214 0.644 0-10 5.17 2.37 5.81 2.30-0.959 0.342 22(61.1) 11(30.6) 3( 8.3) 19(48.7) 17(43.6) 3( 7.7) 1.387 0.500 0-10 5.82 1.91 5.54 2.04 0.615 0.540-14 2 -
9 2 < 2 > (n = 36) (n = 39) n (%) ( ) n (%) ( ) 26(72.2) 31(79.5) 10(27.8) 8(20.5) t or 2 p 0.542 0.462 wk 39.61 1.23 39.67 1.20-0.236 0.814 oxytocin 20(55.6) 16(44.4) 16(44.4) 20(55.6) 22(56.4) 17(43.6) 0.006 0.941 45.75 9.33 43.74 8.68 0.965 0.338 18(46.2) 21(53.8) 0.022 0.882 / hr 68.32 37.00 80.00 35.38-1.162 0.250 gm 3428.89 431.28 3260.79 379.26 1.783 0.079 < 1>. (p = 0.342), (p = 0.500), (p = 0.540). 2) < 2>. 26 (72.2%), 31 (79.5%) 20 (55.6%), 22 (56.4 %). 45.75, 4 3.74 (p = 0.338). 2.. 1) 1 :. < 3>. 4.48 4.49 (t = - 0.002, p = 0.999). 4.94, 6.28 (t = - 2.2 14, p = 0.030). 0.35, 1.83 (t = - 2.407, p = 0.019).,. < 3 > (0-10) (n = 36) (n = 39) ( ) ( ) 4.48 2.28 4.49 2.10 4.94 2.27 6.28 2.63 0.35 2.15 1.83 2.71 t -0.002-2.214-2.407 p 0.999 0.030 0.019-14 3 -
2003 6 1. 2) 2 :. 2 < 4 >. 3cm 75.25, 72.75 (t = 1.064, p = 0.29 1). 75.58, 30 75.13, 1 74.10, 74.03, 30 76.67, 1 77.58. 75 ANCOVA (F = 0.139, p = 0.7 11 ; F = 2.2 53, p = 0.14 0 ; F = 2.6 99, p = 0.108). 2.. < 4 > 75.25 9.28 75.58 6.89 30 75.13 8.41 1 74.10 8.65 (n=36) (n = 39) ANCOVA ( ) ( ) F 72.75 10.62 74.03 10.91 76.67 11.58 77.58 13.83 0.139 2.253 2.699 p 0.711 0.140 0.108 3) 3 :. 3-1 :. 3-2 : Apgar. 3 < 5>. ph 7.331 ph 7.302 (p = 0.124). 3-1.. 1 Apgar 7.92, 7.97 (p = 0.387), 5 Apgar 8.97 (p = 0.979). 3-2 Apgar.. 3.. < 5 > A pg a r (n = 36) (n = 39) t p ( ) ( ) ph 7.331 0.06 7.302 0.07 1.563 0.124 Apgar 1 7.92 0.28 5 8.97 0.17 7.97 0.28 8.97 0.28-0.869-0.027 0.387 0.979 <4 > 4), < 6>. 5 (13.9%), 10 (25.6%). 4.00cm 3.10cm - 144 -
9 2 < 6 > (n = 36) (n = 39) n (%) ( ) n (%) ( ) 5(13.9) 31(86.1) 10(25.6) 29(74.4) t or 2 p 1.616 0.204 0-10cm 4.00 1.54 3.10 8.74 1.561 0.142 3(8.3) 33(91.7) 7(17.9) 32(82.1) 0.313. 30 (p = 0.204). ( 10mg)., 3 (8.3%) 7 (17.9%) (p = 0.313).... () () (SP6).,. (sedatives) (analgesia ) (Lowdermilk, 1999). (Melzack & Wall, 1965), (Bobak, 1995) (Prit char d & Macdonald, 1996)., (2001) Doula - (p = 0.0 14 ) (1998) (p = 0.009). (1995) 5. (1988) (p = 0.002). (2002) (p = 0.194 ) (p = 0.008). - 14 5 -
2003 6 -. opiat e (Lo & Chung, 1979). opioid opioid (Sh er, 1996). enkeph alins (Maxwell, 1997). Lo Chung(1979) 8 6, Hyde (1989) (P 6).,,, (1999), Lyr enas, Lut sch, Hett a Lindber g(1987)--. (p = 0.030) (p = 0.0 19). (2002)., (Sher, 1996). (Budd, Yelland & Maciocia, 1998)., McLachlan (1974 ). (1980) 100,, 1. (2000) (1988)., Wang J in (1989) 98.9%,,, Dunn, Rogers Halfor d (1989) (LV3) TENS TENS. Yanai, Sh aley, Yagu din Zuckerman (1987) 1 (LI4 ) (He7) 20, Apgar. Yip, P ang Sung(1976) 31., - 14 6 -
9 2. 1.,, Suth erland (2000)., ph 7.20 (, 1997 ;, 1999). (acidemia), (199 1). 1, 5 Apgar., 1, 5 Apgar. 43% (, 1999). 44 (58.7%), 40 (53.3%). Florido (1997) - ACTH... placebo contr ol grou p...,... 1.,. 75 (informed consent ) (double- blinded m eth od). 30-14 7 -
2003 6 2 : 3,. 30. SPSS Win 10.0 program t -t est, 2 - t est t-t est, ANCOVA, 2 - t est. 1 ) (p = 0.019) 1. 2) 75.58, 30 75.13, 1 74.10, 74.03, 30 76.67, 1 77.58. ANCOVA (p = 0.711 ; p = 0.140 ; p = 0.108). 2.. 3) ph 7.331 ph 7.302 (p = 0.124) 1 Apgar 7.92, 7.97 (p = 0.387), 5 Apgar 8.97 (p = 0.979). 3-1 3-23....,. 2. 1). 2). 3) (ripening). 4). 5) placebo acupoint. Re f e re n c e s, (1997).. :.,,,, (1999).., 15 (2), 198-202. (1980).,,.. (1978)... (1999)...,,,, (200 1).., 7 (3), 331-34 7.,,, (2002). (SP6) (LI4 )., 8 (2), 244-256. - 14 8 -
9 2 (200 1).. :. (200 1).., 7 (3), 271-283. (1995).., 1 (1), 64-75. (1999).., 5 (2), 265-271. (1997).. :.,, (1992).., 16 (2), 182-19 1. (2002).. - (1994 ).,.. (1988)... (1987). Lam aze..,,, (2002).,,., 8 (4), 538-549. (2003). (SP6),, -..,,, (2002)., - -., 8 (4 ), 348-358. (2001).. :. (2000).., 30 (2), 307-318. (1998)... (1995).,.. 8 (1999).. :., (199 1).. : 10 (1993).. :. (1988)... (2001). Doula, - -., 7 (1), 67-79. (2000).,,.. (199 1). A pgar Score ph Gas.. Bobak, I. M., Lowdermilk, D. L., J ensen M. D.. Mat ernity nursing. Mosby. 1995. Bu dd, S., Yelland, S., Maciocia, G. (1998). A cupu nct ure and herbal treatm ent in m idwifery. In : Maciocia G, edit or. Obst et rics and Gy necology in Chinese Medicine. London : Chur chill Livingst one, 559-575. Ch auh an, P. A., Gasser, F. J., Chauh an, A. M. (1998). Clinical invest igation on th e u se of acupunct ur e for tr eatment of placent al ret ent ion. A m erica J ournal of A cupuncture, 26 (1), 19-25. Cook, A., Wilcox, G. (1997). Pr essuring pain : alt ernat ive th erapies for labor pain management. A W HON N Lifelines, 1 (2), 36-4 1. Du nn, P., Rogers, D., & Halford, K. (1989). Transelect rical st imulat ion at acupunct ur e point s in th e Induction ut erine contr act ions. Obst etrics & Gy necology, 73, 286-290. F lorido, J., Oltr a s, C. M., F aj ardo, M. C., Gonzalens- Esca nu ela, E., Villaver de, C., Gonzalez- Gomez, F. (1997). Plasma concent - r at ions of bet a- endor phin and adr enocorticot ropic h orm one in wom en wirh and wit h out ch ildbir t h pr epa rt ion. E u rop ean J. of Obst et rics & Gy necology and R eprodu ct iv e - 14 9 -
2003 6 Biology, 73, 12 1-125. Green, J. M. (1993). Expect ations and experiences of pain in labor : findings fr om a lar ge pr ospect ive st udy. Birth, 20 (2), 65. Hyde, E. (1989). Acupressure t her apy for m orning sickness. Journal of N ursing- Midwifery, 34 (4 ), 171-178. J imenez, S. (1995). Acupressur e : P ain relief at your fingertips. Int ernational Journal of Childbirth Educat ion, 10 (4), 7-10. Lo, C. W., Chung, Q. T. (1979). The sedat ive effect of acupunct ur e. A m erican Journal of Chinese Medicine, 7 (3), 253-258. Lowdermilk, D. L., P erry, S. E. and Bobak, I. M. (1999). Mat ernity N ursing(5th ed.). 305-327. Mosby. Lyr enas, S., Lut sch, H., Hett a, J., Lindberg, B. (1987). Acupuncture befor e delivery : Effect on labor. Gy necologic and Obst et ric Investigat ion, 24, 2 17-224. Maxwell, J. (1997). Th e gentle power of acu pr essur e. RN, 60 (4), 53-56. McLachlan, E. (1974 ). Recognizing pain. A m erica Journal of N urses, 74 (3), 496-497. Melzack, R., Wall, P. D. (1965). Pain M echanism s. A New th eory, Science. 150, 971. Prit chard, T., Macdonald, P. C. (1996). Obst etrics (20t h ed). New York ; Applet on Century Cr oft. Sher, L. (1996). Th e r ole of t he endogenou s opioid syst em in th e effect of acupunct ur e on m ood and behavior : Th eor etical and pract ical consider ation. A m erica J ournal of A cupuncture, 24 (4 ), 285-290. Sut herland, J. A. (2000). Gett ing t o t he point : Meridian t her apy is m aking it s way int o nur sing practice. A m erica Journal of N ursing, 100 (9), 40-45. Wang, D. W., Jin, Y. H. (1989). Present status of cesarean sect ion u nder acu pu ncture anesth esia in China. Fuk ushim a J Med Sci, 35, 45-52. Yanai, N., Shaley, E., Yagudin, E., Zuckerman, H. (1987). The use of elect roacupuncture during labor. A m erica Journal of A cupu nct ure, 15 (4), 311-312. Yip, S. K., P ang, J. C. K., Sung, M. L. (1976). Induction of labor by acupuncture elect rostimulation. A m erica Journal of Chinese Medicine, 4 (3), 257-265. - Ab s t ra ct - Effe ct s of Sa n - Yin - J ia o (SP6 ) Acu p r es s u r e on An x iet y, Pu ls e a n d Ne on a t a l St a t u s in Wom en d u r in g Lab or Lee, Mi Ky eong 1 ) Pu rpos e : In th e st udy effect s of San-Yin-J iao (SP6) acu pr essure on anxiety and pulse during labor, and on neonat al st at us wer e examined. Met h od : Th e design was a r andomized cont rolled clinical trial with a double-blind m eth od. Dat a wer e collect ed before (pre) and aft er (post ) tr eatment using st ru ct ur ed quest ionnair e, anxiet y scale, pulse rat e, umbilical vein ph and Apgar scores. Th e experiment al grou p r eceived SP6 acupressur e for t he dur ation of each ut erine cont ract ion over period of 30 minut es, but t he cont rol gr oup r eceived SP 6 t ouch. Res u lt s : Th e anxiet y scores between t he two groups increased, but th e incr ease was less in t he SP 6 acu pr essur e gr oup and th e difference was st atistically significant (p = 0.0 19). Mat er nal pulse rat e was not significant ly differ ent immediat ely aft er t reat ment (p = 0.711), at 30 a 1) Inst ructor, Dept. of Nursing, Dankook University - 150 -
9 2 and at 60 minut es (p = 0.140 ; p = 0.108), but while t he SP6 acu pr essure gr oup h ad a st able pulse, t he SP6 t ouch group showed an increased rat e. Ther e was no significant differ ence between th e t wo grou ps for umbilical vein ph (p = 0.124), and neonat al Apgar score at one and five minut es (p = 0.387 ; p = 0.979) Con clu si on : These findings str ength en th e belief th at SP- 6 acu pr essure can be u sed t o r elieve anxiety during labor wit h no side effect s t o eit her mot her or baby. Key w o rds : SP6 acupressure, Wom en in labor, Anxiety, Pulse, Neonat al st atu s - 15 1 -