两种椎管内阻滞麻醉对潜伏期分娩镇痛产妇不同时段体温的影响

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摘要目的比较两种椎管内阻滞麻醉对潜伏期分娩镇痛产妇不同时段体温的影响。方法选择2017年6月～2018年7月河北中石油中心医院收治的240例符合条件的孕足月初产妇，依据随机数字表法分为连续硬膜外阻滞镇痛组（A组）、腰硬联合阻滞组（B组）、对照组（C组），各组80例。A组患者宫口开1～2 cm时给予连续硬膜外阻滞麻醉，实验量给予0.1%盐酸罗哌卡因8 mL，30 min后硬膜外导管接自控电子镇痛泵（电子泵内均配置0.1%盐酸罗哌卡因及0.5 μg/mL舒芬混合液100 mL）。B组患者宫口开1～2 cm时给予腰硬联合阻滞麻醉，蛛网膜下腔注射0.1%罗哌卡因3 mg，30 min后硬膜外导管接自控电子泵。C组产妇正常分娩。分娩结束立即撤出分娩镇痛。分别记录三组产妇入产房时体温、宫口开2 cm时体温、宫口开4 cm时体温、宫口开全时体温、分娩结束后2 h及24 h体温；所有产妇产前及产后24 h抽取静脉血检测C反应蛋白（CRP）及白细胞计数（WBC）水平。结果 A、B组产妇＞37.3℃发热率显著高于C组，差异有统计学意义（P ＜ 0.05）。三组产妇产后CRP水平均较产前升高，且A、B组产妇产后CRP水平高于C组，差异有统计学意义（P ＜ 0.05）。结论两种椎管内麻醉均会导致分娩时体温上升，但产后24 h可恢复正常，其体温升高与感染关系不大。

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	张富杰孟凡浩▲ 赵付华纪云兆

关键词 ：分娩镇痛, 体温, C反应蛋白, 白细胞

Abstract：Objective To compare the effects of two kinds of intraspinal block anesthesia on body temperature during different periods of labor in patients with latent labor analgesia. Methods From June 2017 to July 2018, 240 eligible pregnant who was the first-time mothers in Heibei Petroleum Center Hospital were selected, according to the random number table method, they were randomly divided into continuous epidural block and analgesia group (group A), combined lumbar stiffness block and analgesia group (group B) and no labor analgesia group (group C), 80 cases in each group. Patients in group A were given continuous epidural block anesthesia when the uterine opening was 1-2 cm, and 0.1% Ropivacaine Hydrochloride was given 8 mL. After 30 min, the epidural catheter was connected with the automatic electronic analgesic pump (the electronic pump was equipped with 0.1% Ropivacaine Hydrochloride and 0.5 μg/mL mixed solution of Sufentanil 100 mL). Patients in group B were treated with lumbar hard combined block anesthesia when the uterine opening was 1-2 cm, followed by subarachnoid injection of 0.1% Ropivacaine 3 mg. After 30 minutes, the epidural catheter was connected with the automatic electronic pump. Group C was in normal delivery. Withdrawing the labor analgesia when the delivery was ending. The maternal temperature was measured at the time of delivery, the temperature at 2 cm of the uterine opening, the temperature at 4 cm of the uterine opening, the temperature at the full time of the uterine opening, and the temperature at 2 h and 24 h after the delivery in three groups. All parturients were tested for CRP and WBC by venous blood sampling before and after 24 h. Results The fever rate of ＞37.3℃ in group A and group B was significantly higher than that in group C, and the difference was statistically significant (P ＜ 0.05). Postpartum CRP levels of three groups were higher than those of prenatal women, and the levels of postpartum CRP in group A and group B were higher than those in group C, the differences were statistically significant (P ＜ 0.05). Conclusion Both kinds of intraspinal anesthesia can cause the rise of body temperature during childbirth, but it can return to normal 24 h after delivery. The increase of body temperature has little relationship with infection.

Key words： Labor analgesia Body temperature C reactive protein White blood cells

基金资助:河北省廊坊市科学技术研究与发展计划自筹经费项目（2016013185）。

通讯作者: ▲通讯作者

引用本文:

张富杰孟凡浩▲ 赵付华纪云兆. 两种椎管内阻滞麻醉对潜伏期分娩镇痛产妇不同时段体温的影响[J]. 中国医药导报, 2019, 16(19): 121-123,132.
ZHANG Fujie MENG Fanhao▲ ZHAO Fuhua JI Yunzhao. Effects of two kinds of intraspinal block anesthesia on body temperature during different periods of labor in patients with latent labor analgesia. 中国医药导报, 2019, 16(19): 121-123,132.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2019/V16/I19/121

[1] Tian F，Wang K，Hu J，et al. Continuous spinal anesthesia with sufentanil in labor analgesia can induce maternal febrile responses in puerperas [J]. Int J Clin Exp Med，2013， 6（5）：334-341.
[2] Chen SY，Lin PL，Yang YH，et al. The effects of different epidural analgesia formulas on labor and mode of delivery in nulliparous women [J]. Taiwan J Obstet Gynecol，2014， 53（1）：8-11.
[3] 甘果，李诚，袁力勇，等.瑞芬太尼病人静脉自控镇痛用于分娩镇痛[J].医学研究杂志，2011，40（9）：87-91.
[4] 薛璇，侯雯雯，贾瑞喆，等.硬膜外分娩镇痛下产间发热临床分析[J].南京医科大学学报：自然科学版，2013（12）：1763-1765.
[5] Mantha VR，Vallejo MC，Ramesh V，et al. Maternal and cord serum cytokine changes with continuous and intermittent labor epidural analgesia：a randomized study [J]. Scientific World J，2012，2012：607938.
[6] Riley LE，Celi AC，Onderdonk AB，et al. Association of epidural-related fever and noninfectious inflammation in term labor [J]. Obstet Gynecol，2011，117（3）：588-595.
[7] de Orange FA，Passini RJ，Amorim MM，et al. Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery：a randomized clinical trial [J]. Br J Anaesth，2011，107（5）：762-768.
[8] Irestedt L. The rise in maternal temperature associated with regional analgesia in labour is harmful and should be treated [J]. Int J Obstet Anesth，2003，12（4）：284-286.
[9] 冯艳，张广兰.硬膜外分娩镇痛与产时发热的关系[J].中华围产医学杂志，2012，15（6）：368-370.
[10] Baker A，Meert T. Morphine and D-amphetamine nullify each others′ hypothermic effects in mice [J]. Pharmacol Toxicol，2003，92（2）：64-70.
[11] Goetzl L，Evans T，Rivers J，et al. Elevated maternal and fetal serum interleukin-6 levels are associated with epidural fever [J]. Am J Obstet Gynecol，2002，187（4）：834-838.
[12] Baker AK，Meert TF. Functional effects of systemically administered agonists and antagonists of mu，delta，and kappa opioid receptor subtypes on body temperature in mice [J]. J Pharmacol Exp Ther，2002，302（3）：1253-1264.
[13] de Orange FA，Passini RJ，Amorim MM，et al. Combined spinal and epidural anaesthesia and maternal intrapartum temperature during vaginal delivery：a randomized clinical trial [J]. Br J Anaesth，2011，107（5）：762-768.
[14] Salmi P，Kela J，Arvidsson U，et al. Functional interactions between delta- and mu-opioid receptors in rat thermoregulation [J]. Eur J Pharmacol，2003，458（1-2）：101-106.
[15] Sevarino FB，Johnson MD，Lema MJ，et al. The effect of epidural sufentanil on shivering and body temperature in the parturient [J]. Anesth Analg，1989，68（4）：530-533.
[16] Romanovsky AA. Thermoregulation：some concepts have changed. Functional architecture of the thermoregulatory system [J]. Am J Physiol Regul Integr Comp Physiol，2007，292（1）：R37-R46.
[17] Anim-Somuah M，Smyth RM，Cyna AM，et al. Epidural versus non-epidural or no analgesia for pain management in labour [J]. Cochrane Database Syst Rev，2018， 5：D331.
[18] Dashe JS，Rogers BB，McIntire DD，et al. Epidural analgesia and intrapartum fever：placental findings [J]. Obstet Gynecol，1999，93（3）：341-344.
[19] Sharma SK，Rogers BB，Alexander JM，et al. A randomized trial of the effects of antibiotic prophylaxis on epidural-related fever in labor [J]. Anesth Analg，2014， 118（3）：604-610.