硬膜外相关产时发热对产妇炎症应激反应、母婴结局的影响

Effect of epidural-related maternal fever on maternal inflammatory response and maternal and infant outcomes

目的探讨硬膜外相关产时发热对产妇炎症应激反应、母婴结局的影响。方法回顾性分析2021年4月—2022年3月于芜湖市第一人民医院产科接受椎管内硬膜外分娩镇痛的150例产妇临床资料。按镇痛后是否发热分为对照组和发热组,分别有120例和30例。比较两组基本临床资料、分娩镇痛期间宫缩情况、炎症因子、应激反应及围产期母婴结局。结果两组产妇年龄、孕周、体质量指数、孕次、产次、镇痛前体温、镇痛时间比较,差异无统计学意义(P>0.05)。两组产妇宫口开2 cm时的宫缩间隔时间、宫缩持续时间比较,差异无统计学意义(P>0.05)。发热组产妇宫口开至4 cm、宫口开全时的宫缩间隔时间、宫缩持续时间长于对照组(P<0.05)。两组产妇宫口开2 cm时的血清白细胞介素1β(IL-1β)、IL-6、超敏C反应蛋白(hs-CRP)水平比较,差异无统计学意义(P>0.05)。发热组产妇宫口开全时的血清IL-1β、IL-6、hs-CRP水平高于对照组(P<0.05)。两组产妇宫口开2 cm时的血清皮质醇(Cor)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)水平比较,差异无统计学意义(P>0.05)。发热组产妇宫口开全时的血清Cor、AngⅡ、NE水平高于对照组(P<0.05)。发热组抗生素使用率、胎儿宫内窘迫发生率、中转剖宫产率高于对照组,自然分娩率低于对照组。两组产妇产钳助产率比较,差异无统计学意义(P>0.05)。发热组新生儿并发症总发生率高于对照组(P<0.05)。结论硬膜外相关产时发热未造成产妇宫缩减弱,但会增加产妇炎症应激反应,降低自然分娩率,抗生素使用量增加,增加新生儿并发症发生风险。

Objective To evaluate the effect of epidural-related maternal fever on maternal inflammatory response and maternal and infant outcomes.Methods Retrospective analysis was performed on the clinical data of150 women who received epidural analgesia during labor in our hospital from April 2021 to March 2022.The pregnant women were divided into control group(120 cases)and fever group(30 cases)according to whether fever occurred after the analgesia.The general clinical data,uterine contraction under the condition of analgesia during labor,inflammatory factors,stress response and perinatal maternal and infant outcomes were compared between the two groups.Results There was no significant difference in the age of pregnant women,gestational weeks,BMI,the number of pregnancy,the number of delivery,the body temperature before analgesia,and the duration of analgesia(P>0.05).The interval and duration of uterine contraction when the cervix dilated 2 cm were not different between the two groups(P>0.05),while they were longer in fever group than those in control group when the cervix dilated4 cm and opened to the full dilatation(P<0.05).The serum levels of interleukin(IL)-1β,IL-6,high-sensitivity Creactive protein(hs-CRP),cortisol(Cor),angiotensin II(Ang II)and norepinephrine(NE)were not different between the two groups when the cervix dilated 2 cm(P>0.05),while they were higher in fever group than those in control group when the cervix opened to the full dilatation(P<0.05).The proportions of antibiotic use,fetal distress and conversion to cesarean section in the fever group were higher than those in the control group,where the proportion of spontaneous delivery was lower in the fever group than that in the control group(P<0.05).The overall incidence of neonatal complications was higher in the fever group than that in the control group(P<0.05).Conclusions Epidural-related maternal fever does not result in weakening of uterine contraction,but it may aggravate the maternal inflammatory response,reduce the rate of spontaneous delivery,and increase the use of antibiotics and the risk of neonatal complications.