摘要
目的研究接受自控硬膜外镇痛(PCEA)分娩的产妇发生硬膜外分娩镇痛相关产时发热(ERMF)的影响因素。方法回顾分析2019年4月至2020年8月在南京大学医学院附属鼓楼医院接受PCEA分娩镇痛的387例产妇的临床资料。根据产妇是否发生ERMF分为2组ERMF组(81例)、对照组(306例),比较两组间基本信息、妊娠合并症、产前用药、PCEA时宫口扩张、产时情况、视觉模拟评分法(VAS)的疼痛评估、满意度和新生儿Apgar评分,并进行二元logistic回归分析。结果二元logistic分析显示,PCEA时宫口扩张程度小(OR=1.402,95%CI为1.049~1.874,P=0.022)是ERMF的危险因素,增加产妇ERMF发生风险。总产程时间短(OR=0.848,95%CI为0.785~0.915,P=0.000)、产前应用抗菌药物(OR=0.425,95%CI为0.238~0.760,P=0.004)、产前应用硫酸镁(OR=0.215,95%CI为0.060~0.766,P=0.018)是ERMF的保护因素,降低产妇ERMF的发生风险。ERMF的发生未影响产妇对PCEA分娩镇痛效果的满意度和新生儿Apgar评分(P>0.05)。结论ERMF的影响因素包括PCEA时宫口扩张程度、总产程、产前应用抗菌药物和硫酸镁。可据此对ERMF高危产妇进行初步预判,在产程中密切监测产妇体温,提前准备好母体和胎儿的处置措施,便于ERMF发生时的及时处理。
Objective:To study the influencing factors of epidural-related maternal fever(ERMF)in parturients receiving patient-controlled epidural analgesia(PCEA).Methods:From April 2019 to August 2020,387 parturients who received PCEA labor analgesia in Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School were enrolled in this study with random sampling method,and their clinical data were retrospectively analyzed.According to the occurrence of ERMF,the parturients were divided into two groups:ERMF group(81 cases)and control group(306 cases).The basic information,pregnancy complications,prenatal medication,timing of PCEA administration,intrapartum situation,visual analogue scale(VAS)of pain score,satisfaction and neonatal Apgar score were compared between the two groups,and logistic regression analysis was performed.Results:Logistic regression analysis showed that low degree of uterine dilatation during PCEA(OR=1.402,95%CI:1.049~1.874,P=0.022)was the risk factor of ERMF and increased the risk of ERMF.The short total duration of labor(OR=0.848,95%CI:0.785~0.915,P=0.000),prenatal application of antibiotics(OR=0.425,95%CI:0.238~0.760,P=0.004),and prenatal application of magnesium sulfate(OR=0.215,95%CI:0.060~0.766,P=0.018)was the protective factor of ERMF and reduced the risk of maternal ERMF.The occurrence of ERMF did not affect the satisfaction of parturients with PCEA and Apgar score of newborns(P>0.05).Conclusion:The influencing factors of ERMF include the degree of dilatation of uterine orifice,the total stage of labor,antenatal use of antibiotics and magnesium sulfate.Based on this,we can make a preliminary prediction for the women who are at high risk to ERMF,closely monitor the maternal temperature during the labor process,and prepare the maternal and fetal treatment measures in advance,so as to facilitate the timely treatment of ERMF.
作者
梅洪梁
谢菡
张海霞
葛卫红
戴毅敏
Mei Hongliang;Xie Han;Zhang Haixia(Department of Pharmacy,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008;Nanjing Medical Center for Clinical Pharmacy,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008)
出处
《现代妇产科进展》
CSCD
北大核心
2022年第2期81-85,共5页
Progress in Obstetrics and Gynecology
基金
南京药学会-常州四药医院药学科研基金资助课题(No:2021YX004)
国家自然科学基金资助项目(No:81903870)
江苏省药学会-恒瑞医院药学基金科研项目(No:H202107)。
