硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的影响

Effect of magnesium sulfate on maternal intrapartum fever in parturients with preeclampsia undergoing epidural labor analgesia

目的探讨硫酸镁对子痫前期产妇硬膜外分娩镇痛产时发热的疗效及安全性。方法选择单胎、头位、子痫前期初产妇125例,年龄23~33岁,BMI 23~29 kg/m^2,ASAⅡ或Ⅲ级。随机分为两组,硫酸镁组(M组,n=66)和对照组(C组,n=59)。M组分娩镇痛前经静脉输注硫酸镁50 mg/kg,持续20 min;C组同样方法静脉输注等容量5%葡萄糖。输注完毕后两组行硬膜外分娩镇痛。分别记录产妇镇痛前、镇痛后1、2、3、4、5 h和分娩时的鼓膜温度、产时发热率和VAS疼痛评分。测定两组镇痛前、镇痛后2 h、分娩时血清IL-6浓度。记录两组产程、分娩方式、催产素用量、产后出血量、分娩镇痛药量、分娩镇痛时间及不良反应、新生儿1、5 min Apgar评分等。结果与镇痛前比较,镇痛后4、5 h、分娩时M组鼓膜温度明显升高,镇痛后3、4、5 h、分娩时C组鼓膜温度明显升高(P<0.05);镇痛后1、2、3、4、5 h和分娩时两组VAS疼痛评分均明显降低(P<0.05);镇痛后2 h、分娩时两组血清IL-6浓度均明显升高(P<0.05)。与C组比较,M组镇痛后5 h、分娩时鼓膜温度明显降低(P<0.05),镇痛后2 h血清IL-6浓度明显降低(P<0.05),分娩镇痛药量明显减少(P<0.05)。两组产时发热率、VAS疼痛评分、产程、分娩方式、催产素用量、产后出血量、新生儿Apgar评分、分娩镇痛时间及不良反应差异无统计学意义。结论预先静脉输注50 mg/kg硫酸镁有助于缓解子痫前期产妇硬膜外分娩镇痛产时发热。

Objective To evaluate the safety and efficacy of intravenous magnesium sulfate on maternal intrapartum fever in parturients with preeclampsia undergoing epidural labor analgesia.Methods A total of 125 parturients diagnosed preeclampsia,with a singleton fetus in vertex presentation,aged 23-33 years,BMI 23-29 kg/m^2,ASA physical statusⅡorⅢ,were randomly allocated into magnesium group(group M,n=66)and control group(group C,n=59).Group M received intravenous magnesium sulfate 50 mg/kg within 20 minutes prior to labor analgesia.Group C received the same volume of intravenous 5%glucose within 20 minutes prior to labor analgesia.After that epidural labor analgesia was administered in both groups.Maternal tympanic temperature,febrile rate and visual analogue score(VAS)were evaluated at the beginning of analgesia,1,2,3,4,and 5 hours post analgesia and parturition.Maternal serum interleukin-6(IL-6)levels were also obtained at the beginning of analgesia,2 hours post analgesia and parturition.Adverse effects such as labor duration,delivery mode,oxytocin dosage,postpartum hemorrhage,analgesic consumption,analgesic time,and 1 and 5 minutes-Apgar scores of noenatus were also recorded.Results Compared with the beginning of analgesia,tympanic temperature in group M rose significantly at 4 and 5 hours after analgesia and parturition,tympanic temperature in group C rose significantly at 3,4,and 5 hours after analgesia and parturition(P<0.05),VAS scores at 1,2,3,4,5 hours post analgesia,and parturition decreased significantly in two groups after labor analgesia(P<0.05),and serum IL-6 levels showed a significant rise in two groups 2 hours after analgesia and parturition(P<0.05).Compared with group C,tympanic temperature in group M were lower than those in group C 5 hours after analgesia and parturition(P<0.05),serum IL-6 levels in group M were significantly lower 2 hours after analgesia(P<0.05),and group M got less usage of analgesic consumption(P<0.05).There were no significant differences between two groups in febrile rate,VAS scores,labor duration,delivery mode,oxytocin dosage,postpartum hemorrhage,Apgar scores of neonatus,analgesic time,and adverse effects.Conclusion Prophylactic intravenous magnesium sulphate 50 mg/kg may safely attenuate maternal tympanic temperature rises in parturients with preeclampsia undergoing epidural labor analgesia.