硬膜外分娩镇痛后产时发热的影响因素分析

Analysis of influential factors of fever during labor after epidural labor analgesia

目的探讨接受硬膜外分娩镇痛产妇出现产时发热的影响因素。方法选取寿光市人民医院2020年10月~2021年11月接受硬膜外分娩镇痛的产妇400例作为研究对象,将镇痛后体温≥37.5℃的产妇纳入发热组,体温<37.5℃的产妇纳入对照组,比较两组的一般资料、疾病情况(妊娠期糖尿病、妊娠合并贫血)和产时相关情况,通过卡方检验和Logistic回归分析产时发热的影响因素。结果所纳入的400例研究对象中20.7%产妇出现产时发热。单因素分析结果示:产妇年龄(P=0.045)、产次(P=0.041)、生产过程中是否使用缩宫素(P=0.044)、内诊次数(P<0.001)以及镇痛时机(P<0.001)与硬膜外分娩镇痛后出现产时发热相关。Logistic多因素分析结果示:内诊次数(OR=2.745,95%CI:1.112-6.677)、镇痛时机(OR=2.316,95%CI:0.938-5.714)和羊水污染(OR=1.880,95%CI:0.759-4.658)是影响硬膜外分娩镇痛后产时发热的独立危险因素。发热组和对照组在体质指数(BMI)、孕周、妊娠合并疾病(妊娠期糖尿病、妊娠合并贫血)及生产过程中是否人工破膜方面,差异均没有统计学意义(P>0.05)。结论适当减少内诊次数,延后镇痛时机、控制羊水污染等方法能够有效降低产时发热发生率,预防新生儿不良结局发生。

Objective To investigate the influencing factors of parturient fever in epidural analgesics.Methods From October 2020 to November 2021,a total of 400 pregnant women received epidural delivery analgesia in Shouguang People's Hospital were selected as the research objects.The pregnant women whose body temperature was≥37.5℃after analgesia were included in the fever group,and those whose body temperature was<37.5℃were included in the control group.The general information,disease conditions(diabetes in pregnancy,anemia in pregnancy)and related conditions at birth of the two groups were compared.Chi⁃square test and Logistic regression were used to analyze the influencing factors of fever during labor.Results Among 400 subjects included in the study,20.7%of them had fever during childbirth.The results of univariate analysis showed that the age of the parturient(P=0.045),the number of births(P=0.041),whether to use oxytocin during the production process(P=0.044),the number of internal visits(P<0.001)and the time of analgesia(P<0.001)were correlated with the occurrence of fever during labor after epidural labor analgesia.Logistic multivariate analysis showed that the frequency of internal diagnosis(OR=2.745,95%CI:1.112-6.677),the time of analgesia(OR=2.316,95%CI:0.938-5.714)and the contamination of amniotic fluid(OR=1.880,95%CI:0.759-4.658)were independent risk factors for postpartum fever after epidural analgesia.There was no statistically significant difference between the fever group and the control group in terms of body mass index(BMI),gestational week,pregnancy associated diseases(pregnancy diabetes,pregnancy associated anemia),and whether artificial membrane rupture occurred during production(P>0.05).Conclusion Appropriate methods such as reducing the number of internal visits,delaying the timing of analgesia,and controlling amniotic fluid pollution can effectively reduce the incidence of fe⁃ver during labor and prevent adverse neonatal outcomes.