硬膜外分娩镇痛所致产时发热的研究进展

Research progress of intrapartum fever caused by epidural labor analgesia

随着硬膜外镇痛技术的推广及产妇对减轻产痛需求的增加,越来越多的医疗机构陆续开展分娩镇痛工作。而硬膜外镇痛所致产时发热(ERMF)可能带来的母婴不良结局,却困扰着无数的医疗工作者,产时发热的发生发展机制仍未明确,猜想可能与促炎细胞因子介导的无菌性炎症反应、产妇体温调节功能失衡、局麻药的作用、硬膜外穿刺创伤等有关。产时发热可能增加对产程的干预,增加剖宫产率和抗生素使用,也会影响新生儿神经系统,增加新生儿抗生素暴露。因此,更全面地了解ERMF的原因及危害,有利于针对病因采取有效措施,降低其发生率,改善母婴临床结局。

With the popularization of epidural analgesia technology and the increasing demand for parturients for reducing labor pain,more and more medical institutions have carried out labor analgesia.However,the adverse outcomes of maternal and infant caused by epidural related maternal fever(ERMF)have perplexed countless medical workers.The underlying pathophysiological processes of intrapartum fever remain elusive.It may be related to aseptic inflammatory reaction mediated by proinflammatory cytokines,the imbalance of maternal thermoregulation,the effect of local anesthetics,epidural puncture trauma and so on.Intrapartum fever may increase obstetric interventions,increase the rate of cesarean section,assist vaginal deliveries,and the use of antibiotics.It may affect the neonatal nervous system and increase neonatal antibiotic exposure.Therefore,a more comprehensive understanding of the etiology and harm of ERMF is conducive to taking effective measures to reduce its incidence and allow a better outcome of both mothers and infants.