Tian Fubo, Wang Kai, Hu Jianying, Xie Yi, Sun Shen, Zou Zui, Huang Shaoqiang
Department of Anesthesiology, Shanghai Obstetrics and Gynecology Hospital, Fudan University 128 Shenyang Road, Shanghai 200090, China.
Int J Clin Exp Med. 2013 May 22;6(5):334-41. Print 2013.
Several studies documented persistent hypothermia in parturients after spinal anesthesia, while others reported that labor analgesia was related to a high incidence of fever. Continuous spinal labor anesthesia with sufentanil (CSLAS) is a new effective technique in labor analgesia but whether it affects maternal temperature has not been clarified. The aim of our study was to explore the relationship between CSLAS and maternal intrapartum temperature during vaginal delivery.
75 healthy term nulliparas of spontaneous labor were randomized to receive CSLAS during delivery in sufentanil group (n=37) or non-pharmacological methods of pain relief in control group (n=38). The maternal tympanic temperature was recorded at each time points we required during labor. IL-6, IL-8 and TNF-α were sampled at baseline (before analgesia) and 5 minutes after delivery. The data on visual analog scale (VAS) in all puerperas, first and second stage durations of labor, vaginal examination, oxytocin augmentation, maternal and neonatal antibiotic therapy, maternal and neonatal infection, need for cesarean section, need for instrumental delivery and Apgar scores were all collected from the patients' medical records.
Baseline characteristics of parturients in the 2 groups were not significant differences. After intrathecal injection of sufentanil, the sensation of pain was attenuated by a wide margin in the sufentanil group compared with the control group. Nine parturients in the sufentanil group (24.32%) and two in the control group (5.26%) had a tympanic temperature above 38°C during the labor (p=0.024). In each group, there was a tendency that maternal temperature elevated gradually with time elapsing and reached the peak value 5 hours after baseline. The changes had significant difference from 3 hours to 7 hours after analgesia compared with baseline. Maternal serum IL-6 and IL-8 levels were increased during the labor, while TNF-α did not vary at any time point in each group. 1 min and 5 min Apgar scores were not significant difference in the two groups and no neonate developed temperature above 38°C in the first 24 hours and with antibiotic therapy.
The technique of continuous sufentanil spinal labor anesthesia is a safe and effective method in labor analgesia; however, it is associated with an increased incidence of maternal fever.
多项研究记录了脊麻后产妇持续体温过低的情况，而其他研究则报告分娩镇痛与高热发生率较高有关。舒芬太尼持续脊麻分娩镇痛（CSLAS）是一种新的有效的分娩镇痛技术，但它是否会影响产妇体温尚不清楚。我们研究的目的是探讨阴道分娩期间CSLAS与产妇产时体温之间的关系。
75例健康足月单胎初产妇随机分为舒芬太尼组（n = 37）在分娩时接受CSLAS或对照组（n = 38）采用非药物镇痛方法。在分娩过程中我们要求的每个时间点记录产妇的鼓膜温度。在基线（镇痛前）和分娩后5分钟采集IL-6、IL-8和TNF-α样本。所有产妇的视觉模拟评分（VAS）、第一和第二产程时间、阴道检查、催产素加强、产妇和新生儿抗生素治疗、产妇和新生儿感染、剖宫产需求、器械助产需求及阿氏评分的数据均从患者病历中收集。
两组产妇的基线特征无显著差异。鞘内注射舒芬太尼后，与对照组相比，舒芬太尼组的疼痛感觉明显减轻。舒芬太尼组9例产妇（24.32%）和对照组2例产妇（5.26%）在分娩期间鼓膜温度高于38°C（p = 0.024）。每组中，产妇体温均有随时间逐渐升高并在基线后5小时达到峰值的趋势。与基线相比，镇痛后3小时至7小时体温变化有显著差异。分娩期间产妇血清IL-6和IL-8水平升高，而每组中TNF-α在任何时间点均无变化。两组1分钟和5分钟阿氏评分无显著差异，且在最初24小时内及接受抗生素治疗后无新生儿体温高于38°C。
舒芬太尼持续脊麻分娩镇痛技术是一种安全有效的分娩镇痛方法；然而，它与产妇发热发生率增加有关。
