产时发热峰值及发热持续时间对母婴围产期不良结局的影响  

The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes

作　　者：张佩丽 胡鹏[1] 郭静宜 林华亮 ZHANG Peili;HU Peng;GUO Jingyi;LIN Hualiang(Department of Epidemiology,School of Public Health,Sun Yat-sen University,Guangzhou 510080,China;Department of Gynaecology and Obstetrics,Shantou Central Hospital,Shantou 515031,China;Administration Department of Nosocomial Infection,Guangzhou First People′s Hospital,Guangzhou 510180,China)

机构地区：[1]中山大学公共卫生学院流行病学系,广州510080 [2]汕头市中心医院妇产科,汕头515031 [3]广州市第一人民医院感染管理科,广州510180

出　　处：《中华疾病控制杂志》2024年第8期903-908,共6页Chinese Journal of Disease Control & Prevention

基　　金：广东省自然科学基金(2022A1515010420);国家自然科学基金(81972993)。

摘　　要：目的探讨母体产时发热体温峰值和发热持续时间对母婴围产期结局的影响。方法选取2020―2022年在汕头市中心医院妇产科分娩的足月单胎初产妇,以产时发热(母体体温≥37.5℃)为暴露因素,分别以发热峰值T_(max)(产时能记录到的最高体温)、发热持续时间t(从首次记录发热到首次记录正常体温或分娩为止的时间),发热复合变量v[v=Tmax−37℃/100×t]分组。比较新生儿围产期不良结局(包括新生儿窒息、新生儿感染、缺血缺氧性脑病、惊厥、颅内出血等)和孕产妇围产期不良结局(包括母体手术产、产后出血、手术切口感染、产褥期败血症)差异。采用多因素logistic回归分析模型分析母体产时发热峰值及发热持续时间与母婴围产期不良结局之间的关联。结果本研究共纳入2197例研究对象,其中307名(13.9%)产妇在分娩期间出现发热。与非发热组相比,发热组新生儿不良结局及母体手术产发生风险升高。在调整混杂因素后,发热峰值每增加1℃,新生儿不良结局发生风险增加1.204倍(OR=2.204,95%CI:1.691~2.423),母体手术产发生风险增加88.3%(OR=1.883,95%CI:1.581~2.242);发热持续时间每增加60 min,新生儿不良结局发生风险增加28.4%(OR=1.284,95%CI:1.178~1.400),母体手术产发生风险增加29.4%(OR=1.294,95%CI:1.183~1.414);发热复合变量每增加1个单位,新生儿不良结局发生风险增加55.4%(OR=1.554,95%CI:1.359~1.777),母体手术产发生风险增加49.4%(OR=1.494,95%CI:1.298~1.720)。结论随着发热峰值的升高,发热持续时间增加,发热复合变量增加,新生儿不良结局及母体手术产发生风险均增加。Objective To explore the impact of maternal intrapartum fever′s peak and duration on perinatal outcomes.Methods This study included primiparas who delivered at term with a singleton fetus in the Shantou Central Hospital from 2020 to 2022.The exposure factor was intrapartum fever(the maternal body temperature≥37.5℃).The participants were grouped based on different fever peak(T_(max),the highest recorded body temperature during labor),fever duration(t,the time from the first recorded fever to the first recorded normal body temperature or delivery),and fever composite variable v,[v=Tmax−37℃/100×t].The study compared the differences in neonatal outcomes(including neonatal asphyxia,neonatal infections,hypoxic-ischemic encephalopathy,seizures,intracranial hemorrhage,etc.)and adverse perinatal outcomes of pregnant women(including maternal operative delivery,postpartum hemorrhage,incision infection,puerperal sepsis).Logistic regression analysis was conducted to assess the association between the peak and duration of intrapartum fever and adverse perinatal outcomes.Results A total of 2197 parturients were included in the study,and 307(13.9%)of them had intrapartum fever.Compared with afebrile parturients,febrile parturients had higher rates of neonatal adverse outcomes and maternal operative delivery.After adjusting for confounding factors,for every 1℃increase in fever peak,the risk of adverse neonatal outcomes increased by 1.204 times(OR=2.204,95%CI:1.691-2.423),and the risk of maternal operative delivery increased by 88.3%(OR=1.883,95%CI:1.581-2.242);for every 60-minute increase in the duration of fever,the risk of adverse neonatal outcomes increased by 28.4%(OR=1.284,95%CI:1.178-1.400),and the risk of maternal operative delivery increased by 29.4%(OR=1.294,95%CI:1.183-1.414);for every 1 unit increase in the composite variable of fever,the risk of adverse neonatal outcomes increased by 55.4%(OR=1.554,95%CI:1.359-1.777),and the risk of maternal operative delivery increased by 49.4%(OR=1.494,95%CI:1.298-1.720

关 键 词：产时发热 发热峰值 发热持续时间 母体结局 新生儿不良结局 母体手术产 

分 类 号：R714[医药卫生—妇产科学] R181.1[医药卫生—临床医学]