Department of Anesthesiology, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu 210004, China.
Chin Med J (Engl). 2020 Mar 5;133(5):597-605. doi: 10.1097/CM9.0000000000000646.
Labor is a complex process and labor pain presents challenges for analgesia. Epidural analgesia (EA) has a well-known analgesic effect and is commonly used during labor. This review summarized frequently encountered and controversial problems surrounding EA during labor, including the labor process and maternal intrapartum fever, to build knowledge in this area.
We searched for relevant articles published up to 2019 in PubMed using a range of search terms (eg, "labor pain," "epidural," "analgesia," "labor process," "maternal pyrexia," "intrapartum fever").
The search returned 835 articles, including randomized control trials, retrospective cohort studies, observational studies, and reviews. The articles were screened by title, abstract, and then full-text, with a sample independently screened by two authors. Thirty-eight articles were included in our final analysis; 20 articles concerned the labor process and 18 reported on maternal pyrexia during EA.
Four classic prospective studies including 14,326 participants compared early and delayed initiation of EA by the incidence of cesarean delivery. Early initiation following an analgesia request was preferred. However, it was controversial whether continuous use of EA in the second stage of labor induced adverse maternal and neonatal outcomes due to changes in analgesic and epidural infusion regimens. There was a high incidence of maternal pyrexia in women receiving EA and women with placental inflammation or histologic chorioamnionitis compared with those receiving systemic opioids.
Early EA (cervical dilation ≥1 cm) does not increase the risk for cesarean section. Continuous epidural application of low doses of analgesics and programmed intermittent epidural bolus do not prolong second-stage labor duration or impact maternal and neonatal outcomes. The association between EA and maternal pyrexia remains controversial, but pyrexia is more common with EA than without. A non-infectious inflammatory process is an accepted mechanism of epidural-related maternal fever.
分娩是一个复杂的过程，分娩疼痛给镇痛带来了挑战。硬膜外镇痛（EA）具有良好的镇痛效果，在分娩过程中广泛应用。本综述总结了分娩过程中 EA 常见且存在争议的问题，包括产程和产妇产时发热，以增加该领域的知识储备。
我们使用多种搜索词（例如，“分娩疼痛”、“硬膜外”、“镇痛”、“产程”、“产妇发热”、“产时发热”）在 PubMed 上搜索截至 2019 年发表的相关文章。
搜索结果返回 835 篇文章，包括随机对照试验、回顾性队列研究、观察性研究和综述。首先根据标题和摘要筛选文章，然后由两名作者独立筛选全文，选择 38 篇文章进行最终分析；其中 20 篇文章涉及产程，18 篇报告了 EA 期间的产妇发热。
四项包括 14326 名参与者的经典前瞻性研究比较了 EA 早期和延迟启动对剖宫产率的影响。产妇提出镇痛要求后早期启动 EA 更受青睐。然而，第二产程持续应用 EA 是否会因镇痛和硬膜外输注方案的改变而导致母婴不良结局仍存在争议。与接受全身阿片类药物的产妇相比，接受 EA 的产妇和胎盘炎症或组织学绒毛膜羊膜炎的产妇发热发生率更高。
早期 EA（宫颈扩张≥1cm）不会增加剖宫产的风险。低剂量阿片类药物持续硬膜外应用和程序化间断硬膜外推注不会延长第二产程时间，也不会影响母婴结局。EA 与产妇发热之间的关联仍存在争议，但发热在 EA 组比非 EA 组更常见。硬膜外相关产妇发热的一个被接受的机制是无感染性炎症过程。
