摘要
目的构建腰硬联合麻醉分娩镇痛相关产时发热的危险因素模型,并提出针对性防范策略。方法回顾性分析行腰硬联合分娩镇痛的产妇202例为研究对象。根据是否发生产时发热(母体口腔体温峰值≥38℃)分为发生产时发热组32例和未发生产时发热组170例。比较2组产妇一般资料;采用多因素Logistic回归分析法分析腰硬联合分娩镇痛产妇产时发热的危险因素;采用Hosmer-Lemeshow检验评估模型拟合优度;绘制受试者工作特征(ROC)曲线评价模型预测效果。结果2组使用球囊促宫颈成熟、羊水污染、分娩镇痛时间、产程时间、产前白细胞(WBC)计数、产前C反应蛋白(CRP)水平比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,使用球囊促宫颈成熟、羊水污染、产程时间>9 h、分娩镇痛时间>5 h、产前WBC>10×10^(9)/L、产前CRP水平>10 mg/L是腰硬联合麻醉分娩镇痛相关产时发热的危险因素(P<0.05)。Hosmer-Lemeshow检验显示,模型拟合优度良好;根据预测值和真实值绘制ROC曲线,曲线下面积(AUC)为0.869(95%CI:0.815-0.912),说明模型预测价值良好。当最佳截断值>13.2时,敏感度为78.12%,特异度为85.29%,显著性水平P<0.001,模型预测价值良好。结论使用球囊促宫颈成熟、羊水污染、分娩镇痛时间>5 h、产程时间>9 h、产前WBC>10×10^(9)/L、产前CRP水平>10 mg/L是腰硬联合麻醉分娩镇痛相关产时发热的危险因素,值得临床关注。
Objective To establish a risk factor model of labor fever associated labor analgesia by combined spinal and epidural anesthesia,and to propose targeted prevention strategies.Methods A retrospective analysis was performed for 202 cases of parturience analgesia in combination with combined spinal and epidural anesthesia.According to whether the fever occurred during childbirth(peak maternal oral body temperature≥38℃)or not,the patients were divided into fever during childbirth group(32 cases)and without fever during childbirth group(170 cases).The general data of the two groups were compared;the multiple Logistic regression analysis was used to analyze the risk factors of parturient fever in parturient parturient analgesic labor;the Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model;the receiver operating characteristic(ROC)curve was drawn to evaluate the prediction effect of the model.Results There were statistically significant differences in cervical maturation promotion,amniotic fluid contamination,labor analgesia time,labor time,prenatal white blood cell(WBC)count and prenatal C-reactive protein(CRP)level between the two groups(P<0.05).Logistic regression analysis showed that the use of balloon for cervical maturation,amniotic fluid contamination,labor time>9 h,labor analgesia time>5 h,prenatal WBC>10×10^(9)/L,prenatal CRP level>10 mg/L were risk factors for labor fever associated with lumbo-hard labor analgesia(P<0.05).Hosmer-Lemeshow test showed that the model had a good goodness of fit;ROC curve was drawn according to the predicted value and the true value,and the area under the curve(AUC)was 0.869(95%CI,0.815 to 0.912),indicating good predictive value of the model.When the optimal cut-off value was>13.2,the sensitivity was 78.12%,the specificity was 85.29%,and the significance P value was less than 0.001,indicating that the model had good predictive value.Conclusion The use of balloon to promote cervical maturation,amniotic fluid contamination,labor analgesia time>5 h,labor tim
作者
刘伟武
曾伟兰
徐敏兰
徐秀英
周树强
杜政莲
LIU Weiwu;ZENG Weilan;XU Minlan;XU Xiuying;ZHOU Shuqiang;DU Zhenglian(Department of Obstetrics,Yulin Maternal and Child Health Hospital in Guangxi Zhuang Autonomous Region,Yulin,Guangxi,537000)
出处
《实用临床医药杂志》
2023年第11期38-42,共5页
Journal of Clinical Medicine in Practice
基金
广西壮族自治区卫生健康委员会自筹经费科研项目(Z20210920)。
关键词
腰硬联合麻醉
分娩镇痛
产妇
产时发热
危险因素
防范策略
combined spinal and epidural anaesthesia
labor analgesia
puerpera
intrapartum fever
risk factors
preventive strategy
