硬膜外分娩镇痛相关发热对产妇分娩方式和助产方式的影响

Effect of epidural labor analgesia-related fever on maternal mode of delivery and mode of delivery assistance

目的研究硬膜外分娩镇痛引起的发热对产科分娩方式和助产方式的影响。方法对2020年1-6月于济宁医学院附属医院接受硬膜外分娩镇痛的孕妇病例进行回顾性队列研究。孕妇行硬膜外分娩镇痛后,根据有无发热将其分为发热组和非发热组。研究主要结局是硬膜外分娩镇痛相关发热对产科分娩方式,助产方式的影响,次要结局是抗生素使用情况以及新生儿因呼吸窘迫综合征或脓毒症收入重症医学病房(intensive care unit,ICU)的发生情况。结果本研究开始纳入856例孕妇,最终574例孕妇符合标准并对其临床资料进行了分析,其中硬膜外分娩镇痛相关发热128例(发热组),未发热446例(未发热组)。发热组剖宫产发生率为16.4%,未发热组剖宫产发生率7.3%,二者差异具有统计学意义(P<0.05)。抗生素使用情况在发热组12.5%,未发热组2.2%,差异具有统计学意义(P<0.001)。两组经阴分娩产妇之间助产、侧切以及新生儿因呼吸窘迫综合征或脓毒血症入ICU差异没有统计学意义(P>0.05)。结论硬膜外分娩镇痛引起的非感染性发热会增加产妇剖宫产发生率以及孕妇围产期抗生素使用率,但对于经阴助产需求以及新生儿因呼吸窘迫综合征或脓毒血症入ICU情况影响差异无统计学意义。

Objective To examine the impact of epidural labor analgesia-induced fever on obstetric delivery mode and delivery assistance mode.Methods A retrospective cohort study was conducted.Pregnant women who received epidural labor analgesia from January 2020 to June 2020 were enrolled.Pregnant women undergoing epidural labor analgesia were devided into fever and non-fever groups based on the presence or absence of fever.The primary outcome was the effect of epidural labor analgesia-associated fever on obstetric mode of delivery,mode of delivery assistance.Secondary outcomes were antibiotic usage and the occurrence of neonatal admission to the ICU for respiratory distress syndrome or sepsis.Results The study began with the inclusion of 856 pregnant women,and eventually 574 pregnant women were analyzed,including 128 fever cases and 446 non-fever cases.The incidence of cesarean delivery was 16.4%in the epidural labor analgesia fever group and 7.3%in the nonfever group(P<0.05),with statistically significant differences.The use of antibiotic was 12.5%in the fever group and 2.2%in the non-fever group(P<0.001),with significant difference.No difference was shown in assisted delivery,lateralization,and neonatal admission to ICU for respiratory distress or sepsis between the two groups of laboring women via vaginal delivery.Conclusions Non-infectious fever caused by epidural labor analgesia increases the incidence of maternal cesarean delivery and the use of perinatal antibiotics in pregnant women,but there is no statistically significant on the need for transvaginal assisted delivery and neonatal admission to the ICU for respiratory distress or sepsis.