静脉应用地塞米松对子痫前期孕妇硬膜外相关产时发热的影响  

Effects of intravenous dexamethasone on epidural -related intrapartum fever in pregnant womenundergoing preeclampsia

作　　者：李文静[1] 钟美琴 渠银平[3] 沈洪艳[1] 周霞[4] 张青林[5] Li Wenjing;Zhong Meiqin;Qu Yinping(Department of Anesthesiology,Tengzhou Maternal and Child Health Hospital,Zaozhuang 277599,China)

机构地区：[1]滕州市妇幼保健院麻醉科,枣庄277599 [2]滕州市妇幼保健院科教科,枣庄277599 [3]滕州市妇幼保健院质量管理办公室,枣庄277599 [4]滕州市妇幼保健院院感管理办公室,枣庄277599 [5]首都医科大学附属北京妇产医院/北京妇幼保健院麻醉科

出　　处：《中华保健医学杂志》2023年第3期304-306,共3页Chinese Journal of Health Care and Medicine

基　　金：枣庄市医药卫生科技发展计划项目(202006)。

摘　　要：目的 评价静脉应用地塞米松对子痫前期孕妇硬膜外相关产时发热的影响。方法 前瞻选取2021年1月~6月在山东省枣庄市滕州市妇幼保健院待产的120例子痫前期孕妇,所有孕妇均自愿接受硬膜外分娩镇痛,采用随机数表法为PE组(罗哌卡因推注)和PE+D组(罗哌卡因+地塞米松),每组60例。所有孕妇在硬膜外间隙推注负荷量0.062 5%罗哌卡因7~10 ml,PE+D组在硬膜外间隙推注负荷量的同时,静脉入壶地塞米松10 mg。采取患者自控镇痛模式。记录两组孕妇在硬膜外镇痛前和镇痛后各时点的白介素6(IL-6),IL-10和肿瘤坏死因子(TNF-α)水平;记录产时发热、剖宫产和产钳发生率,以及新生儿的Apgar评分。结果 与PE组相比,PE+D组在镇痛后各时点的IL-6、IL-10和TNF-α水平显著较高,差异有统计学意义(P<0.05)。与分娩镇痛前相比,PE组镇痛后各时点的IL-6、IL-10和TNF-α水平显著增高,差异有统计学意义(P <0.05)。PE+D组镇痛后30 min时的IL-6、IL-10和TNF-α水平最高;镇痛后60 min已经回复到镇痛前水平;镇痛后24 h明显降低,差异有统计学意义(P <0.05)。与PE组相比,PE+D组孕妇的产时发热发生率、剖宫产率和产钳率要更低,差异有统计学意义(P <0.05)。两组新生儿的Apgar评分差异无统计学意义(P> 0.05)。结论 静脉应用地塞米松对子痫前期孕妇的炎性反应和硬膜外相关产时发热的有一定的防治作用。Objective To investigate the effect of intravenous dexamethasone on epidural-related intrapartum fever in pregnant women undergoing preeclampsia.Methods From January 2021 to June 2021,120 pregnant women aged 20~45 years who were diagnosed as preeclampsia and could attempt vaginal delivery were selected as the study subjects.All the pregnant women voluntarily accepted epidural labor analgesia.They were divided into PE group and PE+D group according to the random number method,with 60 cases in each group.All pregnant women were injected with 0.0625%ropivacaine 7~10 ml in epidural space,but in PE+D group,10 mg dexamethasone was injected intravenously.They adopt the mode of patient-controlled epidural analgesia.The levels of IL-6,IL-10 and TNF-αwere recorded the time points before and after labor analgesia.And the incidence of intrapartum fever,cesarean section and forceps were recorded.Neonatal Apgar scores were recorded.Results The levels of IL-6,IL-10 and TNF-αwere lower in PE+D group at each time point after analgesia(P<0.05);In PE group:the levels of IL-6,IL-10 and TNF-αincreased significantly at at each time point after analgesia(P<0.05);In PE+D group:the level of IL-6,IL-10 and TNF-αincreased significantly at the time point of 30 min after analgesia(P<0.05).Not only they recoveried to the original level at the time point of 60 min after analgesia(P>0.05),but also decreased significantly at the time point of 24 hours after analgesia(P<0.05).The incidence of postpartum fever,cesarean section and forceps in PE+D group were lower than that of PE group(P<0.05).Conclusion Intravenous dexamethasone can significantly reduce the inflammatory reaction and epidural-related intrapartum fever in pregnant women with preeclampsia.

关 键 词：硬膜外分娩镇痛 产时发热 子痫前期 地塞米松 炎性反应 

分 类 号：R714[医药卫生—妇产科学]