足月分娩时硬膜外相关发热与非感染性炎症的相关性。
Association of epidural-related fever and noninfectious inflammation in term labor.
机构信息
From the Departments of Obstetrics and Gynecology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, Massachusetts; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Medicine, Clinical Microbiology Laboratory, and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Anesthesia, Critical Care and Pain Medicine, Division of Obstetric Anesthesia, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts.
出版信息
Obstet Gynecol. 2011 Mar;117(3):588-595. doi: 10.1097/AOG.0b013e31820b0503.
OBJECTIVE
To investigate the role of infection and noninfectious inflammation in epidural analgesia-related fever.
METHODS
This was an observational analysis of placental cultures and serum admission and postpartum cytokine levels obtained from 200 women at low risk recruited during the prenatal period.
RESULTS
Women receiving labor epidural analgesia had fever develop more frequently (22.7% compared with 6% no epidural; P=.009) but were not more likely to have placental infection (4.7% epidural, 4.0% no epidural; P>.99). Infection was similar regardless of maternal fever (5.4% febrile, 4.3% afebrile; P=.7). Median admission interleukin (IL)-6 levels did not differ according to later epidural (3.2 pg/mL compared with 1.6 pg/mL no epidural; P=.2), but admission IL-6 levels greater than 11 pg/mL were associated with an increase in fever among epidural users (36.4% compared with 15.7% for 11 pg/mL or less; P=.008). At delivery, both febrile and afebrile women receiving epidural had higher IL-6 levels than women not receiving analgesia.
CONCLUSION
Epidural-related fever is rarely attributable to infection but is associated with an inflammatory state.
目的
探究感染和非感染性炎症在硬膜外镇痛相关发热中的作用。
方法
本研究为前瞻性观察性分析，纳入了 200 名低危产妇，在产前采集了她们的胎盘培养物、入院时和产后的细胞因子水平。
结果
接受分娩硬膜外镇痛的产妇发热更为常见（22.7% vs. 6% 未行硬膜外镇痛；P=.009），但发生胎盘感染的几率并无差异（4.7% vs. 4.0%；P>.99）。无论产妇是否发热，感染的发生率相似（5.4% 发热，4.3% 不发热；P=.7）。入院时白细胞介素（IL）-6 水平与之后是否行硬膜外镇痛无关（3.2 pg/mL 比 1.6 pg/mL；P=.2），但入院时 IL-6 水平大于 11 pg/mL 与硬膜外镇痛使用者发热发生率增加相关（36.4% 比 15.7%；P=.008）。分娩时，无论是否发热，接受硬膜外镇痛的产妇 IL-6 水平均高于未接受镇痛的产妇。
结论
硬膜外相关发热很少由感染引起，而是与炎症状态有关。
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