规律间断给药用于硬膜外分娩镇痛对产妇产间发热的影响

Effects of regular intermittent bolus used for epidural labor analgesia on maternal intrapartum fever

目的评价规律间断给药用于硬膜外分娩镇痛对产妇产间发热(体温≥38℃)的影响。方法选择2012年10月至2014年8月在我院行硬膜外分娩镇痛的产妇120例,随机均分为两组:规律间断给药组(RIB组),每小时给予单次剂量10ml(0.08%罗哌卡因8mg+0.4μg/ml舒芬太尼4μg),持续给药组(CI组),按10ml/h速度持续给药。记录硬膜外镇痛前、镇痛后1、2、3、4、5h、分娩时、分娩后1h产妇的鼓膜体温、硬膜外感觉阻滞水平和血清白细胞介素6(IL-6)水平,并计算产妇产间发热发生率。结果镇痛后4、5h、分娩时、分娩后1h两组产妇鼓膜体温明显高于镇痛前(P<0.05或P<0.01);镇痛后1、2、3、4、5h、分娩时、分娩后1h时IL-6水平明显高于镇痛前(P<0.01)。镇痛后3、4hRIB组VAS评分明显低于CI组(P<0.05)两组产间发热发生率差异无统计学意义。结论规律间断给药与持续给药用于硬膜外分娩镇痛产妇产间发热发生率相近,体温升高可能与IL-6水平的升高有关,但镇痛效果更佳。

Objective To determine the effects of regular intermittent bolus used for epidural labor analgesia on maternal intrapartum fever. Methods This randomized trial was performed in Nan- jing Maternity and Child Health Care Hospital between October 2012 and August 2014. Either regu- lar intermittent bolus （RIB, n=60） or continuous infusion （CI, n=60） was used for epidural labor analgesia. Bolus close （10 ml of 0. 08% ropivacaine＋0. 4 μg/ml sufentanil） was manually administra- ted once an hour in the RIB group, whereas the same concentration solution was continuously infused at a constant rate of 10 ml/h in group CI. Maternal tympanic temperature and serum interleukin 6 （IL-6） level were measured hourly from baseline to 1,2,3,4,5 h after epidural labor analgesia, till in- terapastum and 1 h post parturru The incidences of fever （≥38 ℃） were calculated. Results The in- cidence of maternal fever were no difference between the two groups. As for mean temperature and IL-6, there were rising trends parturition in both groups, but no statistical difference was detected be- tween two groups at respective time points. Conclusion Compared with continuous infusion, regular intermittent bolus presents same incidence of maternal fever for epidural labor analgesia, IL-6 eleva- tion could be involved in mean maternal temperature increase, but the analgesic effect is more better.