Ke-Xin Jin, Shuo Wang, Xing-Rong Song, Jun-Li Zhang, Jing Yan, Bing Li, Zi-Wen Shi, Qian Luo, Xiang-Dong Wang, Feng Jiang, Xu Ding, Yuan Zeng, Yao-Wu Bai, Jin Zhang, Jun-Xiang Jia, Yuan-Yan Tu, Bo Lei, Ai-Rong Bao, Chun-Mei Deng, Ting Ding, Daniel I Sessler, Dong-Xin Wang
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引用次数: 0
Abstract
Background: Some women receiving epidural labour analgesia become hyperthermic. Assuming a causal mechanism, denser and more extensive sympathetic blocks might promote hyperthermia by inhibiting sweating. We therefore tested the hypothesis that hyperthermia is most common when epidural blocks are particularly effective, as indicated by excellent analgesia.
Methods: In this multicentre prospective observational study, we enrolled nulliparous women with term cephalic singleton pregnancies who planned vaginal delivery with epidural analgesia. Pain intensity was assessed using an 11-point numerical rating scale (0-10) during uterine contractions before analgesia, at 10, 30, and 60 min after initiating analgesia, and then hourly until the end of the third stage, and calculated as time-weighted average, average, area under the curve, and peak scores. Our primary endpoint was intrapartum hyperthermia (≥38°C).
Results: Intrapartum hyperthermia occurred in 13% (124/952) of participants (median age 29 yr). After adjustment for confounding factors, lower pain intensity was associated with higher odds of intrapartum hyperthermia across all four measures: time-weighted average (odds ratio 1.64; 95% CI 1.40-1.91; P<0.001), average (1.56; 1.35-1.81; P<0.001), area under the curve (1.05; 1.03-1.07; P<0.001), and peak scores (1.19; 1.09-1.30; P<0.001). The identified inflection points were a time-weighted average score ≤3 points (odds ratio 8.67; 95% CI 4.19-17.9; P<0.001), average score ≤3 points (6.63; 3.56-12.3; P<0.001), area under the curve ≤30 point⋅h (13.0; 3.75-45.0; P<0.001), and peak score ≤4 points (2.53; 1.65-3.89; P<0.001), all of which were associated with increased intrapartum hyperthermia.
Conclusions: Among nulliparous women receiving epidural analgesia for labour, lower pain scores were associated with higher odds of hyperthermia. Extensive sympathetic blockade may promote maternal hyperthermia.
背景：一些接受硬膜外分娩镇痛的妇女变得高热。假设存在因果机制，更密集和更广泛的交感神经阻滞可能通过抑制出汗来促进高热。因此，我们验证了这样的假设：当硬膜外阻滞特别有效时，热疗是最常见的，正如良好的镇痛所表明的那样。方法：在这项多中心前瞻性观察性研究中，我们招募了计划硬膜外镇痛阴道分娩的无产单胎足月头侧妊娠妇女。采用11分数值评定量表（0-10分）评定镇痛前子宫收缩时、开始镇痛后10、30、60分钟以及每小时至第三期结束时的疼痛强度，并计算时间加权平均值、平均值、曲线下面积和峰值评分。我们的主要终点是产时热疗（≥38°C）。结果：13%（124/952）的参与者（中位年龄29岁）发生了分娩时高热。在调整混杂因素后，在所有四项测量中，较低的疼痛强度与较高的产时高热几率相关：时间加权平均（优势比1.64;95% CI 1.40-1.91; p）结论：在接受硬膜外分娩镇痛的无产妇女中，较低的疼痛评分与较高的高热几率相关。广泛的交感神经阻滞可促进母体体温升高。临床试验注册：NCT04940091。
期刊介绍：
The British Journal of Anaesthesia (BJA) is a prestigious publication that covers a wide range of topics in anaesthesia, critical care medicine, pain medicine, and perioperative medicine. It aims to disseminate high-impact original research, spanning fundamental, translational, and clinical sciences, as well as clinical practice, technology, education, and training. Additionally, the journal features review articles, notable case reports, correspondence, and special articles that appeal to a broader audience.
The BJA is proudly associated with The Royal College of Anaesthetists, The College of Anaesthesiologists of Ireland, and The Hong Kong College of Anaesthesiologists. This partnership provides members of these esteemed institutions with access to not only the BJA but also its sister publication, BJA Education. It is essential to note that both journals maintain their editorial independence.
Overall, the BJA offers a diverse and comprehensive platform for anaesthetists, critical care physicians, pain specialists, and perioperative medicine practitioners to contribute and stay updated with the latest advancements in their respective fields.
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