硬膜外分娩镇痛相关产时发热的研究进展

Research Progress of Intrapartum Fever Re-lated to Epidural Labor Analgesia

随着无痛分娩观念的普及和产妇对减轻产痛需求的增加,越来越多的医疗机构响应政策开展无痛分娩工作。硬膜外分娩镇痛是目前临床上使用最有效且最广泛的分娩镇痛方法,但大量研究表明,分娩镇痛与产时发热相关。引起产时发热的机制尚未阐明,可能与炎症反应、麻醉药物的作用、体温调节失衡、硬膜外穿刺创伤、产妇自身特点及分娩过程等有关。产时发热对产妇和新生儿均可造成不良影响,可能增加对产程的干预、引起剖宫产率升高、且易被误诊为感染从而过度医疗,也会影响新生儿神经系统发育,增加新生儿抗生素暴露等。因此,更全面地了解硬膜外分娩镇痛相关产时发热的机制与危害,对提高分娩镇痛效果和改善母婴临床结局具有重大现实意义。

With the popularity of the notion of painless delivery and the increase in maternal demand to less-en labor pain, an increasing number of medical facilities are implementing painless delivery poli-cies. Epidural labor analgesia is currently the most effective and widely used method of labor anal-gesia in clinical practice, but numerous studies have shown that labor analgesia is associated with intrapartum fever. The mechanism of intrapartum fever has not been elucidated and may be relat-ed to inflammatory response, the role of anesthetic drugs, thermoregulatory imbalance, epidural puncture trauma, maternal characteristics, and delivery process. Intrapartum fever can cause ad-verse effects on both parturients and newborns, which may increase the intervention of labor, cause an increased rate of cesarean section, and be easily misdiagnosed as infection, resulting in unnec-essary medical treatment, but also affect neonatal neurological development and increase antibiotic exposure. Therefore, a more comprehensive understanding of the mechanism and harm of intra-partum fever caused by epidural labor analgesia is of great practical significance to improve labor analgesia and improve maternal and fetal clinical outcomes.