椎管内分娩镇痛致阴道分娩产时发热的临床分析

Intravertebral Anesthesia in Labor Analgesia Can Induce Maternal Intrapartum Fever

目的：探讨椎管内分娩镇痛致阴道分娩过程中产时发热的情况。方法：分析2013年7-12月在我院符合纳入研究条件的4627例阴道分娩的足月单胎头位妊娠孕妇,按是否采用椎管内分娩镇痛,分为椎管内分娩镇痛组（4018例）和无椎管内分娩镇痛组（604例）。记录并对比两组产时发热情况,检测并记录产时发热孕妇发热的时间和在产程开始前及发热时的血常规、C反应蛋白。结果：椎管内分娩镇痛组产时发热率为3.78%（152/4018）,无椎管内分娩镇痛组产时发热率为0.82%（5/609）。椎管内分娩镇痛组产时的发热率明显高于无椎管内分娩镇痛组（P〈0.05）。椎管内分娩镇痛组孕妇产时发热的时间多数出现在椎管内穿刺后3-5小时,尤以4小时时最多,其发热时血白细胞总数为（13.89±3.04）×109/L,C-反应蛋白为（12.52±7.90）mg/L。结论：椎管内分娩镇痛是导致孕妇产时非感染性发热的重要因素,发热时多数情况是无需应用抗生素的。

Objective： This stuty aimed to explore the relastionship between intravertebral labor anesthesia and maternal intrapartum fever without upper respiratory tract infection, urinary tract infection or lower genital track line-infection during vaginal delivery. Methods ：4627 singleton full term pregnant women with vertex presentation were included in this study. According tO whether receiving intravertebral analgesia during vaginal delivery, all pregnant women were divided into two groups,intravertebral anesthesia group and non-intravertebral anesthesia group. The number and period of maternal intrapartum fever in the two groups were recorded and compared. Blood routine and C-reactive protein were tested before labor and being fever, respectively. Results： The rate of maternal intrapartum fever in intravertebral anesthesia group was significantly higher（3.78% ）than non-intraverte- bral anesthesia group（0.82% ）（ P 〈 0.05）. Most of maternal intrapartum fever happend in 3 -5 hours after the puncture in the epidural canal, especially in the 4th hours. When the women had intrapartum fever, the white blood cell was （13. 89 ±3.04） x 10^9/L and C-reactive protein was （12.52 ± 7.90）mg/L. Conclusions： Intravertebral anesthesia is an important factor leading to the noninfectious intrapartum fever of pregnant women during vaginal delivery. There is no need to use antibiotics in most cases.