分娩镇痛产妇产时发热影响因素及其对母婴结局的影响  

Impacting factors of maternal intrapartum fever during labor analgesia and its impacts on maternal and infant outcomes

作　　者：徐敏倩 罗晓红 XU Minqian;LUO Xiaohong(College of Medicine and Life Sciences,Chengdu University of Traditional Chinese Medicine,Sichuan,Chengdu 611130,China)

机构地区：[1]成都中医药大学医学与生命科学学院,四川成都611130

出　　处：《中国医药科学》2022年第18期78-82,共5页China Medicine And Pharmacy

摘　　要：目的探讨分娩镇痛引起产时发热的相关危险因素,并分析产时发热对母婴结局的影响。方法回顾性分析2019年10月1日至2020年7月1日在德阳市人民医院接受分娩镇痛的297例足月初产妇,分为发热组73例,正常组224例,排除中转剖宫产38例,分为研究组(58例)及对照组(201例)。单因素及多因素logistic回归分析产时发热的危险因素对分娩方式及并发症、1 min和5 min新生儿Apgar评分、胎儿窘迫发生率等的影响。结果单因素分析显示:研究组前列腺素制剂的使用率、羊水污染、产时导尿和人工破膜所占比例高于对照组,阴道检查次数多于对照组,第一产程时间长于对照组(P<0.05)。多因素logistic回归分析显示,阴道检查次数[OR=1.259(95%CI:1.087,1.459)],前列腺素制剂的使用[OR=4.122(95%CI:1.892,8.981)],人工破膜[OR=3.089(95%CI:1.395,6.840)],羊水污染[OR=3.695(95%CI:1.743,7.382)]是硬膜外分娩镇痛期间产时发热的危险因素(P均<0.05)。发热组中转剖宫产率高于正常组(20.5%vs.10.3%,P<0.05);两组器械助产率、自然分娩率、新生儿1 min和5 min Apgar评分及胎儿窘迫发生率比较,差异无统计学意义(P>0.05)。研究组抗生素使用比例高于对照组(29.3%vs.4.5%,P<0.05);两组产后尿潴留、宫缩乏力、会阴侧切发生率比较,差异无统计学意义(P>0.05)。结论分娩镇痛期间产时发热导致剖宫产率显著增加,但不增加胎儿及新生儿的不良结局。产时发热与多种因素相关,产程中避免相关因素的叠加。Objective To investigate the related risk factors of intrapartum fever caused by labor analgesia,and analyze the impacts of intrapartum fever on the outcomes of mothers and infants.Methods A total of 297 full-term primiparas who received labor analgesia in the People’s Hospital of Deyang City from October 1,2019 to July 1,2020 were retrospectively analyzed.They were divided into the fever group(n=73)and the normal group(n=224).After excluding 38 cases converting to cesarean section,they were divided into the study group(n=58)and the control group(n=201).Univariate and multivariate logistic regression were used to analyze the risk factors of intrapartum fever and the impacts of intrapartum fever on labor process,delivery mode and complications,Apgar scores of neonates at 1 min and 5 min,incidence of fetal distress,etc.Results Univariate analysis showed that the usage rate of prostaglandins,and proportions of amniotic fluid pollution,intrapartum catheterization and artificial rupture of membranes in the study group were higher than those in the control group,the number of vaginal examinations was more than that in the control group,and the first stage of labor process was longer than that in the control group(P<0.05).Multivariate logistic regression analysis showed that the number of vaginal examinations(OR=1.259[95%CI:1.087,1.459]),the use of prostaglandins(OR=4.122[95%CI:1.892,8.981]),artificial rupture of membranes(OR=3.089[95%CI:1.395,6.840]),and amniotic fluid pollution[OR=3.695(95%CI:1.743,7.382)]were the risk factors for intrapartum fever during epidural labor analgesia(all P<0.05).The rate of conversion to cesarean section in the fever group was 20.5%,higher than 10.3%in the normal group(P<0.05).There were no statistically significant differences between the fever group and the normal group in the rate of instrumental midwifery,nature delivery,Apgar scores of neonates at 1 min and 5 min and incidence of fetal distress(P>0.05).The proportion of antibiotics used in the study group was 29.3%,higher than 4.5%

关 键 词：分娩镇痛 产时发热 人工破膜 阴道检查 

分 类 号：R714.2[医药卫生—妇产科学]