Anaesthetic Department, Chelsea and Westminster NHS Trust, London, UK.
Surgical Outcomes Research Centre, Centre for Perioperative Medicine, Research Department for Targeted Intervention, Division of Surgery and Interventional Science, University College London, London, UK; Health Services Research Centre, National Institute of Academic Anaesthesia, Royal College of Anaesthetists, London, UK.
Br J Anaesth. 2021 Feb;126(2):500-515. doi: 10.1016/j.bja.2020.09.046. Epub 2020 Nov 18.
Epidural analgesia is associated with intrapartum hyperthermia, and chorioamnionitis is associated with neonatal brain injury. However, it is not known if epidural hyperthermia is associated with neonatal brain injury. This systematic review and meta-analysis investigated three questions: (1) does epidural analgesia cause intrapartum hyperthermia, (2) is intrapartum hyperthermia associated with neonatal brain injury, and (3) is epidural-induced hyperthermia associated with neonatal brain injury?
PubMed, ISI Web of Knowledge, The Cochrane Library, and Embase were searched from inception to January 2020 using Medical Subject Headings (MeSH) terms relating to epidural analgesia, hyperthermia, labour, and neonatal brain injury. Studies were reviewed independently for inclusion and quality by two authors (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach). Two meta-analyses were performed using the Mantel-Haenszel fixed effect method to generate odds ratios (ORs) and 95% confidence intervals (CIs).
Forty-one studies were included for Question 1 (646 296 participants), 36 for Question 2 (11 866 021 participants), and two studies for Question 3 (297 113 participants). When the mode of analgesia was randomised, epidural analgesia was associated with intrapartum hyperthermia (OR: 4.21; 95% CI: 3.48-5.09). There was an association between intrapartum hyperthermia and neonatal brain injury (OR: 2.79; 95% CI: 2.54-2.3.06). It was not possible to quantify the association between epidural-induced hyperthermia and neonatal brain injury.
Epidural analgesia is a cause of intrapartum hyperthermia, and intrapartum hyperthermia of any cause is associated with neonatal brain injury. Further work is required to establish if epidural-induced hyperthermia is a cause of neonatal brain injury.
硬膜外镇痛与分娩期体温升高有关，绒毛膜羊膜炎与新生儿脑损伤有关。然而，硬膜外热是否与新生儿脑损伤有关尚不清楚。本系统评价和荟萃分析调查了三个问题：（1）硬膜外镇痛是否导致分娩期体温升高，（2）分娩期体温升高是否与新生儿脑损伤有关，（3）硬膜外引起的体温升高是否与新生儿脑损伤有关？
使用与硬膜外镇痛、发热、分娩和新生儿脑损伤相关的医学主题词（MeSH）术语，从建库到 2020 年 1 月，在 PubMed、ISI Web of Knowledge、Cochrane 图书馆和 Embase 中进行检索。两位作者独立审查纳入和质量（推荐评估、制定与评价分级（GRADE）方法）。使用 Mantel-Haenszel 固定效应方法进行了两项荟萃分析，以生成比值比（OR）和 95%置信区间（CI）。
问题 1 纳入 41 项研究（646296 名参与者），问题 2 纳入 36 项研究（11866021 名参与者），问题 3 纳入 2 项研究（297113 名参与者）。当镇痛方式为随机时，硬膜外镇痛与分娩期体温升高有关（OR：4.21；95%CI：3.48-5.09）。分娩期体温升高与新生儿脑损伤有关（OR：2.79；95%CI：2.54-2.3.06）。无法量化硬膜外引起的体温升高与新生儿脑损伤之间的关联。
硬膜外镇痛是分娩期体温升高的原因，任何原因引起的分娩期体温升高都与新生儿脑损伤有关。需要进一步研究以确定硬膜外引起的体温升高是否是新生儿脑损伤的原因。
