低风险初产妇群体中的产妇硬膜外镇痛与产妇抗生素治疗率

Maternal epidural analgesia and rates of maternal antibiotic treatment in a low-risk nulliparous population.

作者信息

Goetzl Laura, Cohen Amy, Frigoletto Fredric, Lang Janet M, Lieberman Ellice

机构信息

Department of Obstetrics and Gynecology, Baylor College of Medicine, 6550 Fannin Street, Suite 901, Houston, TX 77030, USA.

出版信息

J Perinatol. 2003 Sep;23(6):457-61. doi: 10.1038/sj.jp.7210967.

DOI:10.1038/sj.jp.7210967

PMID:13679931

Abstract

BACKGROUND

Epidural analgesia is associated with an increased rate of fever in prospective randomized trials. While the evidence suggests that epidural fever is not infectious, epidural analgesia has been associated with increased rates of antibiotic use, the indications that prompt treatment have not been examined.

METHODS

We analyzed 1235 nulliparous women with singleton term pregnancies presenting in labor with a temperature of < 99.5 degrees F. Antibiotic use during labor was categorized by indication.

RESULTS

A total of 59.6% of women received epidural analgesia. The rate of antibiotic use was significantly higher in women receiving epidural analgesia (28 vs 10.8%). After adjusting for confounders using logistic regression, epidural analgesia was associated with a relative risk of 2.6 (95% CI 2.0, 3.4) for antibiotic treatment. The majority of the increased risk was due to significantly higher rates of antibiotic treatment for presumed chorioamnionitis (9.0 vs 0.4%) in the epidural analgesia group.

CONCLUSION

Epidural-related fever results in excess maternal antibiotic treatment for presumed chorioamnionitis.

摘要

背景

在前瞻性随机试验中，硬膜外镇痛与发热率增加有关。虽然有证据表明硬膜外发热并非感染性的，但硬膜外镇痛与抗生素使用增加有关，尚未对促使进行治疗的指征进行研究。

方法

我们分析了1235例单胎足月妊娠的未产妇，她们在分娩时体温低于99.5华氏度。分娩期间的抗生素使用按指征分类。

结果

共有59.6%的女性接受了硬膜外镇痛。接受硬膜外镇痛的女性抗生素使用率显著更高（28%对10.8%）。使用逻辑回归对混杂因素进行调整后，硬膜外镇痛与抗生素治疗的相对风险为2.6（95%可信区间2.0，3.4）。风险增加的大部分原因是硬膜外镇痛组中因假定绒毛膜羊膜炎而进行抗生素治疗的比率显著更高（9.0%对0.4%）。