硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用分析

doi:10.11958/20253174

天津医药 ›› 2026, Vol. 54 ›› Issue (4): 364-368.doi: 10.11958/20253174

硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用分析

段程丽¹(), 申彦杰², 郭丽霞¹, 王碧航¹, 俎晓霞¹^△(), 刘玉强³

¹ 长治市人民医院/长治医学院附属第三临床医院产科（邮编046000）
² 长治市人民医院/长治医学院附属第三临床医院麻醉科（邮编046000）
³ 长治市人民医院/长治医学院附属第三临床医院药学部（邮编046000）

收稿日期:2025-10-16 修回日期:2025-11-28 出版日期:2026-04-15 发布日期:2026-04-14
通讯作者: ^△E-mail：tsyzxbg@163.com
作者简介:段程丽（1987），女，主治医师，主要从事产时发热方面研究。E-mail：15536143972@163.com
基金资助:
山西省卫生健康委员会科研课题计划项目(2023109)

Analysis of the interaction between the moment of fever during labor and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome

DUAN Chengli¹(), SHEN Yanjie², GUO Lixia¹, WANG Bihang¹, ZU Xiaoxia¹^△(), LIU Yuqiang³

¹ Department of Obstetrics, Changzhi People's Hospital/Changzhi Medical College Affiliated Third Clinical Hospital, Changzhi 046000, China
² Department of Anesthesiology, Changzhi People's Hospital/Changzhi Medical College Affiliated Third Clinical Hospital, Changzhi 046000, China
³ Department of Pharmacy, Changzhi People's Hospital/Changzhi Medical College Affiliated Third Clinical Hospital, Changzhi 046000, China

Received:2025-10-16 Revised:2025-11-28 Published:2026-04-15 Online:2026-04-14
Contact: ^△E-mail：tsyzxbg@163.com

段程丽, 申彦杰, 郭丽霞, 王碧航, 俎晓霞, 刘玉强. 硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用分析[J]. 天津医药, 2026, 54(4): 364-368.

DUAN Chengli, SHEN Yanjie, GUO Lixia, WANG Bihang, ZU Xiaoxia, LIU Yuqiang. Analysis of the interaction between the moment of fever during labor and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome[J]. Tianjin Medical Journal, 2026, 54(4): 364-368.

摘要/Abstract

摘要：

目的探讨硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用。方法纳入硬膜外镇痛产时发热产妇118例。统计新生儿不良结局发生情况，Logistic回归模型分析产时发热时刻、发热峰值与新生儿不良结局的独立关系及交互作用。采用R 3.6.1软件包和rms程序包构建平滑拟合曲线，分析产时发热时刻、发热峰值阈值效应。结果硬膜外镇痛产时发热产妇新生儿不良结局发生率为36.44%。年龄大、妊娠期糖尿病、发热峰值高均为新生儿不良结局的独立危险因素，产时发热时刻晚为其保护因素（P<0.05）。产时发热时刻短于7.9 h时，新生儿不良结局发生率随产时发热时刻延迟而降低；发热峰值高于38 ℃时，新生儿不良结局发生率随发热峰值升高而升高。产时发热时刻与发热峰值对新生儿不良结局存在负向相加交互作用，在产时发热时刻与发热峰值共存的新生儿不良结局中，39.8%由两者交互作用引起。结论硬膜外镇痛产妇产时发热时刻、发热峰值对新生儿不良结局具有负向相加交互作用。

关键词: 镇痛, 硬膜外, 分娩, 发热, 婴儿, 新生, 产时发热时刻, 发热峰值, 新生儿不良结局

Abstract:

Objective To explore the interaction between the time of intrapartum fever and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome. Methods A total of 118 parturients with fever during labor who received epidural analgesia were included. A statistical analysis was conducted to investigate the occurrence of neonatal adverse outcomes. Logistic regression modeling was utilized to assess the independent association of intrapartum fever onset timing and peak fever magnitude with neonatal adverse outcomes, along with their potential interaction effects. Threshold effect analyse for intrapartum fever timing and peak temperature were performed using restricted cubic splines through the rms package in R version 3.6.1, generating smoothed fitting curves to visualize these relationships. Results The incidence of adverse neonatal outcome in parturients with fever during labor due to epidural analgesia was 36.44%. Older age, gestational diabetes and peak fever were all independent risk factors for adverse neonatal outcome, while later timing of intrapartum fever was a protective factor (P < 0.05). When the duration of fever during labor was shorter than 7.9 hours, the incidence of adverse neonatal outcome decreased with the delay of the duration of fever during labor. When the peak fever was higher than 38 ℃, the incidence of adverse neonatal outcome increased with the increase of the peak fever. There was a negative additive interaction between the moment of fever during labor and the peak of fever on adverse neonatal outcome. Among the adverse neonatal outcomes where the moment of fever during labor and the peak of fever coexist, 39.8% was caused by the interaction between the two. Conclusion The time and peak of fever during labor in parturients with epidural analgesia have a negative additive interaction effect on adverse neonatal outcome.

Key words: analgesia, epidural, parturition, fever, infant, newborn, the moment of fever during labor, peak fever, adverse outcomes of newborns

中图分类号:

R714，R614

图/表 4

参考文献 28

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组别		n	年龄/岁		孕前体质量指数/（kg/m²）			产妇类型			孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
组别		n	年龄/岁		孕前体质量指数/（kg/m²）			初产妇		经产妇	孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
正常组		75	31.99±3.10		23.49±2.59			56（74.67）		19（25.33）	39.42±1.05		13（17.33）		8（10.67）		65（86.67）		38（50.67）
不良组		43	33.26±3.05		23.62±2.75			30（69.77）		13（30.23）	39.37±1.02		7（16.28）		13（30.23）		38（88.37）		24（55.81）
t或χ²			2.154^＊		0.257			0.332			0.252		0.022		7.152^＊＊		0.072		0.290
组别	使用抗生素			产程/h					产时发热情况							新生儿性别（男/女）		新生儿体质量/kg
组别	使用抗生素			第一产程		第二产程	第三产程		产时发热时刻/h			发热峰值/℃		发热持续时间/h		新生儿性别（男/女）		新生儿体质量/kg
正常组	65			12.83±3.78		0.50±0.20	0.17±0.06		8.09±0.76			37.93±0.20		1.34±0.25		38/37		3.30±0.29
不良组	37			13.02±3.91		0.52±0.19	0.18±0.05		7.51±0.80			38.12±0.22		1.37±0.26		23/20		3.27±0.31
t或χ²	0.009			0.260		0.532	0.924		3.914^＊＊			4.788^＊＊		0.618		0.087		0.527

组别		n	年龄/岁		孕前体质量指数/（kg/m²）			产妇类型			孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
组别		n	年龄/岁		孕前体质量指数/（kg/m²）			初产妇		经产妇	孕周/周		妊娠期高血压疾病		妊娠期糖尿病		人工破膜		催引产
正常组		75	31.99±3.10		23.49±2.59			56（74.67）		19（25.33）	39.42±1.05		13（17.33）		8（10.67）		65（86.67）		38（50.67）
不良组		43	33.26±3.05		23.62±2.75			30（69.77）		13（30.23）	39.37±1.02		7（16.28）		13（30.23）		38（88.37）		24（55.81）
t或χ²			2.154^＊		0.257			0.332			0.252		0.022		7.152^＊＊		0.072		0.290
组别	使用抗生素			产程/h					产时发热情况							新生儿性别（男/女）		新生儿体质量/kg
组别	使用抗生素			第一产程		第二产程	第三产程		产时发热时刻/h			发热峰值/℃		发热持续时间/h		新生儿性别（男/女）		新生儿体质量/kg
正常组	65			12.83±3.78		0.50±0.20	0.17±0.06		8.09±0.76			37.93±0.20		1.34±0.25		38/37		3.30±0.29
不良组	37			13.02±3.91		0.52±0.19	0.18±0.05		7.51±0.80			38.12±0.22		1.37±0.26		23/20		3.27±0.31
t或χ²	0.009			0.260		0.532	0.924		3.914^＊＊			4.788^＊＊		0.618		0.087		0.527

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.156	0.075	4.312	0.038	1.169（1.009~1.354）
妊娠期糖尿病	1.322	0.571	5.365	0.021	3.749（1.225~11.471）
产时发热时刻	-0.547	0.211	6.705	0.010	0.578（0.382~0.875）
发热峰值	0.680	0.238	8.153	0.004	1.975（1.238~3.151）
常数项	-7.247	6.920	8.666	0.003	0.002

变量	β	SE	Wald χ²	P	OR （95%CI）
年龄	0.156	0.075	4.312	0.038	1.169（1.009~1.354）
妊娠期糖尿病	1.322	0.571	5.365	0.021	3.749（1.225~11.471）
产时发热时刻	-0.547	0.211	6.705	0.010	0.578（0.382~0.875）
发热峰值	0.680	0.238	8.153	0.004	1.975（1.238~3.151）
常数项	-7.247	6.920	8.666	0.003	0.002

临床表现	总例数	不良结局例数	正常结局例数	OR（95%CI）	P
产时发热时刻（-）/发热峰值（-）	30	11	19	1
产时发热时刻（-）/发热峰值（+）	25	13	12	1.870（1.005~3.480）	<0.001
产时发热时刻（+）/发热峰值（-）	33	7	26	0.465（0.251~0.861）	<0.001
产时发热时刻（+）/发热峰值（+）	30	12	18	1.152（0.497~2.672）	>0.05

硬膜外镇痛产妇产时发热时刻和发热峰值对新生儿不良结局的交互作用分析

Analysis of the interaction between the moment of fever during labor and the peak of fever in parturients with epidural analgesia and adverse neonatal outcome

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