基于倾向性评分匹配分析硬膜外分娩镇痛对产妇产时发热的影响

Analysis the effect of epidural labor analgesia on maternal intrapartum fever based on propensity score matching method

目的基于倾向性评分匹配(PSM)分析硬膜外分娩镇痛对产妇产时发热的影响。方法回顾性分析2022年1月~2022年6月在常州市妇幼保健院经阴道分娩、足月、单胎、头位、年龄20~35岁、ASAⅠ或Ⅱ级的384例初产妇的临床资料,根据是否自愿接受硬膜外分娩镇痛分为镇痛组(250例)和对照组(134例)。镇痛组产妇宫口扩张至3 cm时于L2~L3间隙置入硬膜外镇痛泵,镇痛泵内含0.1%罗哌卡因+0.5μg/ml舒芬太尼。记录基础体温、体重指数(BMI)、胎膜破裂至分娩结束时间、宫颈检查次数、产程时间、缩宫素使用情况和新生儿体重。采集产前和产后24 h的产妇静脉血,测定白细胞计数(WBC)、中性粒细胞计数(NEUT)、血清C反应蛋白(CRP)和血清降钙素原(PCT)浓度。对产时体温≥37.5℃的产妇进行胎盘病理学分析。应用倾向性评分匹配进行配对筛选,镇痛组112例,对照组112例。主要结局指标为产妇产时体温≥37.5℃的发生率。次要结局指标包括:绒毛膜羊膜炎比率、羊水污染情况、新生儿出生后1 min、5 min的Apgar评分。结果与对照组比较,镇痛组产妇产时体温≥37.5℃的发生率升高(P<0.05);两组产妇绒毛膜羊膜炎比率、羊水污染比率差异无统计学意义(P>0.05);两组新生儿出生后1 min、5 min Apgar评分<7比率差异无统计学意义(P>0.05)。结论硬膜外分娩镇痛增加产妇产时发热的发生率,潜在机制可能是非感染因素。

Objective To analyse the effect of epidural labor analgesia on maternal intrapartum fever based on propensity score matching method.Methods We retrospectively analyzed 384 cases of primiparas undergoing successful vaginal delivery from January 2022 to July 2022 in Changzhou Maternal and Health Care Hospital,meeting full term pregnancy with singleton in cephalic presentation,aged 20 to 35 years,ASA gradeⅠ~Ⅱ,who were divided into two groups depended on with or without requesting for epidural labor analgesia:analgesia group,a total of 250 cases,and controlled group,a total of 134 cases.When the cervical dilatation of analgesia group parturients was about 3 cm,a epidural analgesia pump was placed at the L2~L3 interspace containing 0.1%ropivacaine plus 0.5μg/ml sufentanil.The basal body temperature,body mass index(BMI),the time from rupture of fetal membrane to the end of labor,the number of vaginal examinations,the length of labor,use of oxytocin and neonatal weight were recorded.Venous blood samples of parturients at prenatal and 24 h postpartum were collected to detect white blood cells(WBC),neutral granular cells(NEUT),C-reactive protein(CRP),procalcitonin(PCT).Placental pathology analysis was obtained when maternal intrapartum temperature was≥37.5℃.The propensity score matching method was used for paired screening,with 112 cases in analgesia group and 112 cases in controlled group.The primary outcome was incidence of maternal intrapartum temperature≥37.5℃.Secondary outcomes included incidence of chorioamnionitis,amniotic fluids pollution,Apgar scores of newborns at 1min and 5 min after delivery.Results Compared with the control group,the incidence of maternal intrapartum temperature≥37.5℃was significantly higher in the analgesia group(P<0.05).No significant changes were found in chorioamnionitis and amniotic fluids pollution between two groups(P>0.05).There was no significant changes in the incidence of newborn Apgar scores<7 at 1 min and 5 min after delivery between two groups(P>0.05).Conclusion Epidural labor analgesia provided a higher incidence of maternal intrapartum fever,the underlying mechanism may due to non-infection factor.