Brit J Anaesth:硬膜外相关产时发热的预防或干预措施

2022-08-07 MedSci原创 MedSci原创

没有明确的证据支持对硬膜外相关的产时发热使用任何个人预防或治疗干预措施。进一步的研究应集中于了解硬膜外相关的产时发热发生的机制,以使随机对照试验能够采取可能的干预措施,以减少产时发热的发生率。

硬膜外相关的产时发热指接受硬膜外分娩镇痛的产妇在分娩期间的核心温度≥37.5℃或≥38℃。硬膜外相关的产时发热的发生率因研究而异,从1.6%到46%变化不等。硬膜外相关的产时发热对产妇和新生儿都有影响,但没有系统地评估预防策略。

近日,麻醉学领域权威杂志British Journal of Anaesthesia上发表了一篇研究文章,研究人员纳入了评估预防或治疗活产妇女硬膜外相关产时发热方法的随机对照试验,并检索了MEDLINE、EMBASE、CINAHL、Web of Science、CENTRAL等数据库。

两位作者独立地进行了研究选择。数据提取和质量评估由另一名作者完成。研究人员使用Cochrane偏倚风险2工具进行了分析,并采用DerSimonian和Laird随机效应模型对主要结局、产时发热发生率进行Meta分析,得出伴有95%可信区间(95%CI)的总风险比(RRs)。

研究人员纳入了34项研究的42项记录。减少硬膜外麻醉用药剂量的方法降低了硬膜外相关的产时发热发生率,但当6项有高偏倚风险的试验被移除时(7项试验;857名参与者;RR=0.83;95%可信区间为0.41-1.67)。与硬膜外镇痛相比,替代方法的镇痛和高剂量预防性全身类固醇降低了分娩时发热的风险。预防性服用扑热息痛治疗无效。

由此可见,没有明确的证据支持对硬膜外相关的产时发热使用任何个人预防或治疗干预措施。进一步的研究应集中于了解硬膜外相关的产时发热发生的机制,以使随机对照试验能够采取可能的干预措施,以减少产时发热的发生率。

原始出处:

Anna Cartledge.et al.Interventions for the prevention or treatment of epidural-related maternal fever: a systematic review and meta-analysis.British Journal of Anaesthesia.2022.https://www.bjanaesthesia.org/article/S0007-0912(22)00323-3/fulltext

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    2022-11-01 AspirantSuo
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