椎管内阻滞分娩镇痛相关产时发热的研究进展

Advances of intrathecal labor analgesia-related intrapartum fever

椎管内阻滞分娩镇痛是目前对母婴影响最小且最有效的分娩镇痛方式,但大量临床研究表明,分娩镇痛可能与产时发热相关。引起产时发热的机制尚未明确,目前认为可能与体温调节失衡、局麻药物影响以及炎症反应等因素相关。产时发热对产妇及新生儿均可造成不良影响,引起产妇剖宫产率升高、抗生素使用增加以及过度医疗等,同时也可能导致新生儿Apgar评分降低、新生儿脑病发病率及住院率升高。目前有报道表明,激素类药物、低浓度局麻药物以及程控硬膜外间歇脉冲给药方式可以降低产时发热率,但效果有限。

Intrathecal labor analgesia has the least impact on maternal and neonatal health,and is the most effective method for labor analgesia.However,a large number of clinical studies have shown that intrathecal labor analgesia is associated with the intrapartum fever.The underlying mechanism remains unclear.It is believed that the following factors are involved including the imbalance of thermoregulation,drug effects,inflammation,etc.Intrapartum fever can cause adverse outcomes on parturient and neonatus.Intrapartum fever is associated to higher cesarean section rate,more antibiotic usage,and excessive medical treatment,which is also associated with low Apgar score,neonatal encephalopathy rate and high neonatal intensive care unit admission.At present,some studies have found that the use of steroids,low concentration local anesthetic and programmed intermittent epidural bolus can decreases the incidence of intrapartum fever,but the effect is limited.