在分娩期间的外周止痛和新生儿缺氧缺血性脑病变期间的外周止痛
Marie-Coralie Cornet1, Michael W Kuzniewicz2,3, Aaron W Scheffler4
1Department of Pediatrics, Benioff Children Hospital, University of California, San Francisco.
JAMA network open
|September 16, 2024
概括
外周止痛可能会在分娩期间增加母亲的体温,但似乎不会增加新生儿缺氧缺血性脑病变 (HIE) 的风险. 这项大型研究发现,尽管存在温度方面的担忧,但除外套使用与HIE之间没有直接联系.
科学领域:
- 产科和妇科 产科和妇科
- 新生儿医学 新生儿医学
- 麻醉学 麻醉学
背景情况:
- 外周止痛疗法被广泛用于减轻分娩疼痛,在美国约有70%的分娩患者使用它.
- 产妇分娩期间的发烧,通常与外周支架使用有关,是新生儿不良结果的已知危险因素,包括缺氧缺血性脑病变 (HIE).
- 外周止痛与HIE风险之间的直接关联,独立于母亲的体温,需要进一步调查.
研究的目的:
- 调查外围镇痛与新生儿缺氧缺血性脑病变 (HIE) 风险之间的关联.
- 为了调整潜在的混因素,特别是母亲的体温升高和倾向于接受外围注射的倾向.
- 为了澄清HIE上外周止痛的独立风险.
主要方法:
- 一个回顾性,基于人口的队列研究,涉及超过233,000个单独的新生儿出生在35周或更晚的妊娠年龄.
- 数据是从2012年至2019年间15家凯泽永久北加州医院的电子病历中提取的.
- 使用后勤回归来评估外周止痛和HIE之间的关联,控制母亲的温度和倾向得分.
主要成果:
- 外周止痛显著与分娩期间产妇发烧 (温度高于38°C) 的风险增加有关.
- 孕产妇发烧与HIE增加的可能性密切相关,温度每升1度几乎会使几率增加三倍.
- 尽管与发烧有关,但在原始或调整后的分析中,外周止痛本身与增加HIE风险没有统计学上显著的关联.
结论:
- 虽然外周止痛与分娩期间母亲体温升高有关,而外周止痛是已知的HIE风险因素,但它似乎不会独立增加HIE风险.
- 这些发现表明,在分娩期间对母亲的体温进行管理可能对减轻与外围注射相关的潜在新生儿风险至关重要.
- 这项研究为产科和麻醉提供者提供了重要的见解,关于新生儿结局与新生儿结局有关的外周止痛的安全性.
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