硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用分析

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中图分类号：R714，R614 文献标志码：A DOI：10.11958/20253174

Abstract：ObjectiveTo explore the interaction between the time of intrapartum fever andthe peak of fever in parturients with epidural aalgesiaandadverse neonatal outcome.MethodsAtotal of118 parturientswith fever during laborwhoreceivedepidural analgesiawere included.Astatisticalanalysis wasconducted toinvestigate theocurrenceof neonatal adverse outcomes.Logistic regresson modeling was utilized toassesstheindependent assciationof intrapartum feveronset timing and peak fever magnitude with neonatal adverseoutcomes，along with their potential interactioneffects. Threshold efect analyse for intrapartum fevertimingand peak temperature wereperformedusing restricted cubic splines through thermspackageinRversion3.6.1，generatingsmoohed fitingcurves tovisualizetheserelationships.ResultsThe incidence of adverse neonatal outcome in parturients with fever during labor due to epidural analgesia was 36.44% . Older age，gestational diabetesand peak fever wereallindependentrisk factorsforadverse neonataloutcome，whilelatertiming of intrapartum fever was a protective factor （ P<0.05 ）.When the duration of fever during labor was shorter than 7.9 hours，the incidenceofadverseneonataloutcomedecreasedwiththedelayof thedurationoffeverduringlabor.Whenthepeak fever was higher than 38 ，the incidence of adverse neonatal outcome increased with the increase of the peak fever.There was a negativeadditiveinteraction betweenthe momentoffeverduringlaborand thepeak offeveronadverse neonataloutcome. Amongthe adverse neonatal outcomes where the moment of fever during labor and the peak offever coexist，39.8% was caused bythe interactionbetweenthetwo.ConclusionThetime and peakoffeverduring laborinparturients withepidural analgesia have a negative additive interaction effect on adverse neonatal outcome.

Key words：analgesia，epidural; parturition; fever;infant，newborn;the moment of fever during labor;peak fever; adverse outcomes of newborns

硬膜外镇痛作为重要的无痛分娩技术，能有效减轻产妇分娩疼痛感，降低机体耗氧量，为安全分娩提供条件。（剩余11242字）