硬膜外分娩镇痛期间产间发热的影响因素分析

Influencing factors of intrapartum fever during epidural labor analgesia

目的分析硬膜外镇痛分娩产妇发生产间发热的相关影响因素。方法选取2017年1月-2019年1月南京医科大学附属妇产医院产科行硬膜外镇痛分娩的产妇150例作为研究对象。其中,44例发生产间发热(发热组),106例产时体温正常(正常组)。对两组产妇的基线资料、硬膜外镇痛给药方式等因素进行比较,并通过多因素Logistic回归分析产间发热的相关影响因素。结果发热组的初产妇、产前抑郁、产前焦虑占比及体重指数(BMI)高于正常组(P<0.05),胎膜破裂至分娩结束时间、产程、分娩镇痛时间长于正常组(P<0.05),阴道检查次数多于正常组(P<0.05),羊水污染发生率和缩宫素使用率高于正常组(P<0.05),硬膜外镇痛间断给药占比低于正常组(P<0.05)。多因素分析显示:胎膜破裂至分娩结束时间[OR=1.014(95%CI:0.924,1.556)]、产程[OR=1.114(95%CI:0.984,1.526)、阴道检查次数[OR=1.547(95%CI:1.140,3.246)]、分娩镇痛时间[OR=1.122(95%CI:1.036,1.769)]、缩宫素使用率[OR=2.160(95%CI:1.774,2.965)]、BMI[OR=2.324(95%CI:1.057,2.965)]、硬膜外镇痛给药方式[OR=1.322(95%CI:1.247,3.668)]均是硬膜外分娩镇痛期间出现产间发热的危险因素。结论硬膜外镇痛分娩产妇发生产间发热的影响因素众多,如BMI、产程、阴道检查次数、分娩镇痛时间、硬膜外镇痛给药方式等,临床应针对上述影响因素,及时予以干预或调整镇痛给药方案,以减少产间发热风险。

Objective To analyze the influencing factors of interpartum fever in pregnant women with epidural labor analgesia.Methods Among 150 parturients who received epidural analgesia,44 had fever during delivery(fever group)and 106 had normal temperature during delivery(normal group).The general demographic characteristics and epidural analgesia administration were compared between the two groups,and the influencing factors of interpartum fever were identified by logistic multivariate regression analysis.Results In the fever group,the proportion of primipara,prenatal depression,prenatal anxiety and BMI were higher than those in the normal group(P<0.05);The time from rupture of membranes to the end of delivery,labor process and labor analgesia were longer(P<0.05);the frequency of vaginal examination was more(P<0.05);the incidence of amniotic fluid pollution and the use of oxytocin were higher(P<0.05);the percentage of discontinuous epidural analgesia was lower(P<0.05).Multivariate analysis showed that the time from rupture of fetal membranes to the end of delivery[OR=1.014,(95%CI:0.924,1.556)],labor process[OR=1.114,(95%CI:0.984,1.526)],number of vaginal examinations(OR=1.547,(95%CI:1.140,3.246)],labor analgesia time[OR=1.122,(95%CI:1.036,1.769)],oxytocin use[OR=2.160,(95%CI:1.774,2965)],BMI[OR=2.324,(95%CI:1.057,2.965)]and epidural analgesia administration[OR=1.322,95%CI:1.247,3.668)]were all risk factors for intrapartum fever during epidural analgesia.Conclusion There are many factors influencing the occurrence of intrapartum fever(such as BMI,duration of labor,number of vaginal examinations,duration of labor analgesia,administration of epidural analgesia,etc.).In order to reduce the risk of intrapartum fever,we should intervene or adjust the administration of epidural analgesia in time according to the aforementioned factors.