硬膜外分娩镇痛对胎膜早破产妇体温和产时发热率的影响

Effects of epidural analgesia on the maternal temperature and intrapartum fever of premature rupture of membranes during labor

目的探讨硬膜外分娩镇痛对胎膜早破产妇体温及产时发热率的影响。方法采用回顾性队列研究方法,选取2018年1月1日至2月15日在北京市海淀区妇幼保健院产房临产的足月(孕龄≥37周)、头胎、胎膜早破产妇130例,根据产妇是否接受硬膜外分娩镇痛将产妇分为两组:硬膜外分娩镇痛组(n=57)和对照组(n=73)。收集并分析两组产妇的年龄、孕龄、合并症等一般情况;破膜时间、第一产程时间、第二产程时间、分娩方式、产程中使用催产素或地西泮等产科情况及硬膜外分娩镇痛组的镇痛时间;产妇进入产房时体温、产程中体温变化值、观察时长(进入产房至胎儿娩出时间)、是否发热(腋温≥37.5℃)、是否接受感染排查及使用抗生素、产前、产后第一天、产后第二天的血常规白细胞计数和中性粒细胞比率;新生儿体重、身长、娩出即刻脐动脉血气分析、是否接受感染排查及使用抗生素等情况。结果除硬膜外分娩镇痛组产妇的孕周略大于对照组[(39.34±0.96)周vs.(38.83±1.41)周]外,两组产妇的年龄、合并症等一般情况差异无统计学意义。两组产妇的破膜时间、第二产程时间、分娩方式、使用安定的差异无统计学意义,硬膜外分娩镇痛组第一产程明显延长[(505.32±200.15)min vs.(334.73±146.96)min],催产素使用率明显增高(91.2%vs.60.3%),差异具有统计学意义(P<0.05)。两组产妇入产房时的体温、产前和产后第二天的血常规白细胞计数和中性粒细胞比率、新生儿体重、身长、1 min及5 min Apgar评分、胎儿娩出即刻脐动脉血气分析及新生儿抗生素使用率无明显差异。与对照组相比,硬膜外分娩镇痛组产妇观察时长[(689.75±254.00)min vs.(392.07±227.95)min]、产程中体温增高的幅度[(0.49±0.46)℃vs.(0.24±0.30)℃]、发热率(17.5%vs.2.7%)、接受感染排查(12.3%vs.0%)与抗生素治疗的比率(70.2%vs.43.8%)、产后1 d的血常规白细胞计数[(14.47±2.96)×10~9/L vs.(13.09±2.76)×10~9/L]、中性粒细胞比率[(83.4±3.7)%vs.(81.7±4.9)%]及新生儿接受感染排查比率(12.3%vs.0.0%)明显增高,差异具有统计学意义(P<0.05)。与未发热产妇相比,发热产妇接受硬膜外分娩镇痛的比率增加(83.3%vs.39.8%)、观察时长延长[(680.00±218.36)min vs.(503.31±281.87)min]、接受感染排查(100.0%vs.50.8%)与抗生素治疗的比率(50.0%vs.0.8%)及新生儿接受感染排查的比率(50.0%vs.0.8%)增加,差异具有统计学意义(P<0.05)。结论硬膜外分娩镇痛可引起胎膜早破产妇产程中体温增高的幅度增大、产时发热率增加,但该现象与感染无关。

Objective To investigate the effects of epidural analgesia on the maternal temperature and intrapartum fever of premature rupture of membranes during labor.Methods 130 cases of full-term(pregnancy≥37 weeks)primiparas with premature rupture of membranes in Beijing haidian maternal and child health hospital from January 1 st to February 15 th,2018 were included in this retrospective cohort study.The mothers were divided into two groups according to whether they received epidural analgesia:epidural analgesia group(n=57)and control group(n=73).The following items of the two groups were reviewed and analyzed:general conditions(including age,gestational age and complications),rupture time,first stage of labor duration,second stage of labor duration and delivery mode,usage of oxytocin or diazepam during labor,duration of epidural labor analgesia,the temperature on entering the delivery room,the temperature variation during delivery,the observation time(from entering the delivery room to delivery),fever(axillary temperature≥37.5℃)or not,infection screening and antibiotics or not,white blood cell(WBC)count and neutrophil ratio in blood routine examination on antepartum,the first day postpartum,and the second day postpartum;the neonatal weight,length,immediate umbilical artery blood gas analysis at delivery,infection screening and antibiotics or not.Results There was no statistically significant difference in age and complications between epidural analgesia group and control group,but the gestational age in the epidural analgesia group was slightly higher than that in control group[(39.34±0.96)weeks vs.(38.83±1.41)weeks].There was no significant difference between the two groups in the time of membrane rupture,the duration of second stage of labor,the mode of delivery,and the use of diazepam.In the epidural analgesia group,the first stage of labor was longer[(505.32±200.15)min vs.(334.73±146.96)min],and the use rate of oxytocin was higher(91.2%vs.60.3%)(P<0.05).There were no significant differences between the two groups in temperature at entering delivery room,white blood cell count and neutrophil ratio and neonatal weight,body length,Apgar score at 1 min and 5 min,immediate umbilical artery blood gas analysis at delivery,and neonatal antibiotic usage.Compared to the control group,the mothers in epidural analgesic group had longer observation periods[(689.75±254.00)min vs.(392.07±227.95)min],and higher temperature increase during labor[(0.49±0.46)℃vs.(0.24±0.30)℃],incidence of fever(17.5%vs.2.7%),ratio of infection screening(12.3%vs.0%)and antibiotic usage(70.2%vs.43.8%),white blood cell count[(14.47±2.96)×10^9/L vs.(13.09±2.76)×10^9/L]on the first day postpartum,neutrophil ratio[(83.4±3.6)%vs(81.8±4.9)%],and incidence of neonatal infection screening(12.3%vs.0.0%)(P<0.05).Compared with mothers without intrapartum fever,the mothers with intrapartum fever had significantly higher proportion of epidural analgesia(83.3%vs.39.8%),maternal antibiotics administration(50.0%vs.0.8%),maternal(100.0%vs.50.8%)and neonatal(50.0%vs.0.8%)infection screening,and longer period of observation[(680.00±218.36)min vs.(503.31±281.87)min](P<0.05).Conclusion Epidural analgesia can higher the elevation of maternal temperature and the incidence of intrapartum fever in primiparas with premature rupture of membranes,but this phenomenon has nothing to do with infection.