椎管内分娩镇痛后发热患者的妊娠结局研究  

Maternal and Neonatal Outcomes of Febrile Patients with Neuraxial Labor Analgesia

作　　者：高夏 苏晶晶[1] 李韵[1] 陶瑞雪[3] 张东升 尹宗智[1] GAO Xia;SU Jingjing;LI Yun(Department of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Heifei Anhui 230022,China;Anhui Maternal and Child Health Hospital,Heifei Anhui 230001,China;Hefei First People's Hospital,Heifei Anhui 230061,China)

机构地区：[1]安徽医科大学第一附属医院妇产科,安徽合肥230022 [2]安徽省妇幼保健院产科,安徽合肥230001 [3]合肥市第一人民医院妇产科,安徽合肥230061

出　　处：《实用妇产科杂志》2020年第5期385-389,共5页Journal of Practical Obstetrics and Gynecology

基　　金：国家自然科学基金(编号:81300514);安徽省高校自然科学研究项目(编号:KJ2018A0188)。

摘　　要：目的:探讨椎管内分娩镇痛后出现的发热对产妇妊娠结局的影响。方法:回顾性分析2017年11月1日至2018年10月31日于安徽省妇幼保健院行椎管内分娩镇痛后发热的100例患者(观察组)与行椎管内分娩镇痛后未发热的100例患者(对照组)的临床资料。比较两组患者麻醉后体温变化、初次发热时间、发热时子宫颈口扩张情况,发热时胎心变化、分娩和胎儿结局,产前、产时、产后白细胞计数(WBC)、嗜中性粒细胞(N)百分比、C反应蛋白(CRP)及降钙素原、宫腔分泌物培养等炎症指标,胎盘病理分析等指标。结果:椎管内分娩镇痛患者体温升高多发生在麻醉给药后4~6小时,在24小时内恢复。观察组剖宫产率(60.0%)较对照组(24.0%)高,阴道分娩率(32.0%)较对照组(73.0%)低,差异有统计学意义(P<0.05);观察组阴道助产率与对照组比较,差异无统计学意义(P>0.05)。观察组初次体温升高时宫口扩张<6 cm的患者剖宫产率(88.4%)高于阴道分娩率(11.6%);宫口扩张≥6 cm后发生体温升高的患者剖宫产率(38.6%)低于阴道分娩率(61.4%),差异有统计学意义(P<0.05)。观察组发热时WBC、N、CRP、降钙素原升高的比例及产后48小时CRP值较对照组显著增加,差异有统计学意义(P<0.05)。观察组40.0%的患者胎盘存在急性绒毛膜羊膜炎表现,镜下可见大量炎性细胞浸润。观察组产时胎心>160/min的阴道分娩率(21.3%)低于产时胎心≤160/min的41.5%;产时胎心>160/min的阴道助产率(12.8%)高于产时胎心≤160/min的3.8%,差异有统计学意义(P<0.05)。观察组羊水污染发生率(29.0%)高于对照组(8.0%),差异有统计学意义(P<0.001)。两组新生儿出生后5分钟Apgar评分、入住新生儿重症病房比率比较,差异无统计学意义(P>0.05)。结论:椎管内分娩镇痛引起的产时发热导致剖宫产率显著增加,但并不增加产褥感染发生率,不增加胎儿不良结局的发生。Objective:To investigate Maternal and neonatal outcomes of febrile patients receiving neuraxial labor analgesia.Methods:Two hundred women with neuraxial labor analgesia were divided into two groups according to their body temperature after the anesthesia,with 100 febrile patients as the experiment group,and 100 women with body normal temperature as the control group.Body temperature changes,the time when fever first detected,cervical dilation,fetal heart rate(FHR)changes,obstetric and neonatal outcomes were recorded.Included women also tested white blood cells(WBC),neutrophils percentage(N),C-reactive protein(CRP),and procalcitonin in the whole process of delivery.Uterine culture and placental pathology evaluations were also obtained.Results:Body temperature increases mostly occurred within 4 to 6 hours after anesthesia,and recovered within 24 hours.The experimental group had a higher cesarean section rate(60.0%vs.24.0%,P<0.05)and a lower vaginal delivery rate(32.0%vs.73.0%,P<0.05)compared to the control group.There was no difference between two groups in terms of operative vaginal birth(P>0.05).Patients with cervical dilation<6 cm when fever developed had a higher cesarean section rate(88.4%vs.38.6%,P<0.05)and a lower vaginal delivery rate(11.6%vs.61.4%,P<0.05)compared to those with cervical dilation≥6 cm.Febrile patients had increased levels of WBC,N%,and CRP when fever developed,as well as elevated CRP and procalcitonin at 48 h after delivery compared to women in the control group(P<0.05).In the experimental group,40%of patients had sings of acute chorioamnionitis.Febrile patients with FHR>160/min at delivery had a lower vaginal delivery rate(21.3%vs.41.5%,P<0.05)and a higher operative vaginal birth rate(12.8%vs.3.8%,P<0.05)compared to those with FHR≤160/min.The incidence of amniotic fluid pollution in the experimental group was higher than that in the control group(29.0%vs.8.0%,P<0.001).There were no significant differences in Apgar score recorded at five minutes and the neonatal intensive care unit admis

关 键 词：椎管内分娩镇痛 产时发热 妊娠结局 

分 类 号：R714.3[医药卫生—妇产科学]