基于倾向性评分匹配方法探讨产时发热对硬膜外自控镇痛产妇母婴结局的影响  

Influence of intrapartum fever on maternal and infant outcome of patient controlled epidural analgesia puerpera based on propensity score matching methods

作　　者：马欢欢 徐恒[2] 李国琴[1] 张永红 黄光伟[1] MA Huanhuan;XU Heng;LI Guoqin;ZHANG Yonghong;HUANG Guangwei(Department of Anesthesiology,Zunyi Maternal and Child Health Hospital,Guizhou Province,Zunyi 563000,China;不详)

机构地区：[1]贵州省遵义市妇幼保健院麻醉科,563000 [2]湖北省妇幼保健院/湖北省妇女儿童医院,武汉市430000

出　　处：《临床合理用药杂志》2023年第21期34-37,41,共5页Chinese Journal of Clinical Rational Drug Use

基　　金：遵义市科技计划联合资金项目[遵市科合HZ字(2019)225号];湖北省卫生健康委联合基金立项项目(WJ2019H285)。

摘　　要：目的通过倾向性评分匹配(PSM)方法探讨产时发热对硬膜外自控镇痛(PCEA)产妇母婴结局的影响。方法选取2019年8月—2020年8月遵义市妇幼保健院和湖北省妇幼保健院收治的阴道分娩初产妇600例,均行PCEA,根据产时发热发生情况分为发热组78例和未发热组522例。比较2组临床资料及母婴结局。结果发热组与未发热组体质指数(BMI)、产程、镇痛时长、阴道指检次数、新生儿出生体质量比较,差异有统计学意义(P<0.01);通过PSM 1∶1匹配,发热组与未发热组均为71例,2组临床资料比较,差异无统计学意义(P>0.05)。发热组鼓膜体温在产程进展3 h时出现上升,至4 h起出现产时发热。发热组住院时间长于未发热组,分娩后血清白介素-6(IL-6)水平、抗生素使用率高于未发热组,新生儿出生1 min后Apgar评分低于未发热组(P<0.01);2组产钳、侧切占比,缩宫素使用率、产后出血量、新生儿科入住率、胎儿宫内窘迫综合征发生率比较,差异无统计学意义(P>0.05)。结论基于PSM结果显示,产时发热对PCEA产妇母婴结局有一定影响,可加重母体炎症,增加抗生素使用率,延长住院时间,还会影响新生儿身体状况。Objective To discuss the influence of intrapartum fever on maternal and infant outcome of PCEA puerpera based on propensity score matching methods.Methods From August 2019 to August 2020,600 vaginal delivery primipara were selected in Zunyi Maternal and Child Health Hospital and Maternal and Child Health Hospital of Hubei Province,and they were divided into the fever group with 78 cases and the non-fever group with 522 cases.Clinical information and maternal and infant outcome were compared between the two groups.Results There were significant differences of BMI,delivery process,duration of analgesia,times of vaginal finger examination,birth weight of newborn between the fever group and the non-fever group(P<0.01);After PSM 1∶1,71 cases in the fever group and 71 cases in the non-fever group,and there was no significant difference of clinical information(P>0.05).In the fever group,the tympanic membrane temperature increased at 3 h after progress of labor,and intrapartum fever occurred at 4 h after labor.Length of hospital stay of the fiver group was longer than that of the non-fiver group,serum level of IL-6 after deliver and use rate of antibiotic were higher than those of the non-fiver group,Apgar score at 1 min after birth was lower than that of the non-fiver group(P<0.01);There was no significant difference of incidence of incidence of forceps and lateral incision,oxytocin utilization rate,postpartum hemorrhage,neonatal admission rate,incidence of fetal distress syndrome between the two groups(P>0.05).Conclusion Based on PSM results,intrapartum fever has a certain impact on maternal and infant outcomes of PCEA puerpera,it can aggravate maternal inflammation,increase the use rate of antibiotics,prolong length of hospital stay,and also affect the physical condition of newborns.

关 键 词：产时发热 硬膜外自控镇痛 倾向性评分匹配方法 母婴结局 

分 类 号：R714.3[医药卫生—妇产科学]