椎管内镇痛：与产时热的关系

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摘要译文（供参考） 腰硬联合镇痛和硬膜外麻醉对产妇产时温度的影响：一项随机对照试验 

背景： 分娩硬膜外镇痛被认为与产时发热有关。我们设计了这项研究，以研究硬膜外镇痛和腰硬联合镇痛对产妇产时体温的影响。 

方法： 将400名健康初产妇随机分为硬膜外镇痛组（EA组）和腰硬联合镇痛组（CSEA组）。镇痛后每小时测量产妇体温。主要结局指标是产妇发热的发生率，次要结局是镇痛持续时间、完全宫颈扩张镇痛和分娩镇痛。还记录了新生儿结局和其他基本分娩事件。 

结果： 分娩过程中，两组镇痛组产妇体温随时间逐渐升高。然而，CSEA组在镇痛后5小时、6小时和9小时的产妇发热发生率较低，产妇平均体温也较低。此外，与EA组相比，CSEA组的镇痛持续时间、完全宫颈扩张的镇痛时间、分娩的镇痛时间更短，以及硬膜外局部麻醉药的剂量也更少。 

结论： 我们的研究结果表明，与硬膜外镇痛相比，腰硬联合镇痛的产时发热的风险更低。

图1. 随机分为EA组和CSEA组的产妇流程图

图2. 硬膜外组和CSEA组镇痛后平均产妇体温的比较。 所有值表示平均值±SD，*P < 0.05，EA组与CSEA组在镇痛后5h、 6h、 和9h

图3. 发热妇女亚组中硬膜外组和CSEA组镇痛后产妇平均体温的比较

图4. 产妇产时发热（T≧38 EA组和CSEA组镇痛后的温度（°C）

图5. EA组和CSEA组根据母体温度的Kaplan-Meier生存曲线 

原文摘要 

The effects of combined spinal-epidural analgesia and epidural anesthesia on maternal intrapartum temperature: a randomized controlled trial Background: Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature. Methods: Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded. Results: Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group. Conclusion: Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia. Fig. 1 Flow chart of parturient randomized to EA and CSEA group Fig. 2 Comparisons of the mean maternal temperature after analgesia between EA group and CSEA group. All values represent the means±SD. *P < 0.05, EA Group vs CSEA Group at the time points of 5 h, 6 h, and 9 h after analgesia Fig. 3 Comparisons of the mean maternal temperature after analgesia between EA group and CSEA group in the subset of women who develop fever Fig. 4 The incidence of maternal intrapartum fever (T≧38 °C) after analgesia between EA group and CSEA group Fig. 5 Kaplan-Meier survival curve according to maternal temperature in the EA group and CSEA group

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编辑：Michel.米萱

校对：Mijohn.米江