硬膜外分娩镇痛对产时发热和产程相关关系的影响

Effect of epidural analgesia for labor and delivery on the association between fever during labor and labor duration

目的探讨硬膜外分娩镇痛对产时发热和产程相关关系的影响。方法提取2013年1月至2018年10月在国际和平妇幼保健院分娩产妇的电子病历数据并开展观察性队列研究,通过回归方程分析产程和产时发热之间的相关关系,并比较硬膜外镇痛组与非硬膜外镇痛组之间相关系数的差异。结果在37786例入组产妇中,镇痛增加产时发热的风险(校正相对风险为3.37,P<0.05)。产时发热发生率与产程时长呈线性相关(镇痛组r=0.909,P<0.05;非镇痛组r=0.777,P<0.05)。镇痛组的回归线相关系数大于非镇痛组(P<0.05)。在发热产妇中,硬膜外镇痛并未额外增加母婴不良事件的风险。结论经阴道分娩足月初产妇的产时发热发生率与产程的时长呈线性相关,实施硬膜外分娩镇痛可进一步促进产程相关产时发热的发生。

Objective To investigate the effect of epidural analgesia for labor and delivery on the association between fever during labor and labor duration.Methods An observational cohort study was performed based on electronic medical record data extracted from the International Peace Maternity and Child Health Hospital from January 2013 and October 2018.The correlation between labor duration and fever during labor was analyzed by regression equation,and the difference in correlation coefficient between the epidural analgesia and non‑epidural analgesia groups was compared.Results Among 37786 parturient women,epidural analgesia resulted in an increased rate of fever during labor(with an adjusted relative risk of 3.37,P<0.05).The rate of fever during labor was lin‑early correlated with labor duration in both the epidural analgesia(r=0.909,P<0.05)and non‑epidural analgesia(r=0.777,P<0.05)groups.Furthermore,the correlation coefficient of the regression line in the epidural analgesia group was significantly higher than that in the non‑epidural analgesia group(P<0.05).For women with fever during labor,epidural analgesia did not further increase the risk of maternal or neonatal adverse events.Conclusions For nulliparous women in term pregnancy,their labor during delivery rate is linearly associated with labor duration.Epidural analgesia for labor and delivery can further promote the occurrence of fever during labor.