Khanna Puneet, Jain Shikha, Thariani Karishma, Sharma Shashikant, Singh Akhil Kant
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Bhopal, India.
Turk J Anaesthesiol Reanim. 2020 Oct;48(5):350-355. doi: 10.5152/TJAR.2020.50. Epub 2020 Apr 27.
Recent research has focused on inflammation and oxidative stress that is seen in women developing intrapartum fever. The interleukin-6 (IL-6) levels have been found to be elevated in women who receive epidural analgesia and become febrile. This suggests that the epidural itself induces an inflammatory response and it is not a physiologic process of labour. Similar findings with additional proinflammatory mediators and reactive oxygen species seem to support this theory. Epidural analgesia also affects the body's thermoregulatory mechanisms. It causes an increase in shivering and appears to be associated with a decrease in heat dissipation via sweating and hyperventilation, most likely because of blockade of the sympathetic stimulation. Considering these factors, it is probable that epidurals do contribute to the development of the associated fever. There remains the possibility that subclinical chorioamnionitis might be the underlying cause of a subset of maternal intrapartum fevers. In summary, histologic chorioamnionitis and epidural analgesia appear to be the independent contributors to intrapartum fever.
近期的研究聚焦于分娩期发热女性中出现的炎症和氧化应激。已发现接受硬膜外镇痛并发热的女性白细胞介素-6（IL-6）水平升高。这表明硬膜外麻醉本身会引发炎症反应，而不是分娩的生理过程。其他促炎介质和活性氧的类似发现似乎支持这一理论。硬膜外镇痛还会影响人体的体温调节机制。它会导致寒战增加，并且似乎与通过出汗和过度通气散热减少有关，这很可能是由于交感神经刺激受阻。考虑到这些因素，硬膜外麻醉很可能确实会导致相关发热的发生。仍有可能亚临床绒毛膜羊膜炎是一部分产妇分娩期发热的潜在原因。总之，组织学绒毛膜羊膜炎和硬膜外镇痛似乎是分娩期发热的独立促成因素。
