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产时发热峰值及发热持续时间对母婴围产期不良结局的影响

张佩丽 胡鹏 郭静宜 林华亮

张佩丽, 胡鹏, 郭静宜, 林华亮. 产时发热峰值及发热持续时间对母婴围产期不良结局的影响[J]. 中华疾病控制杂志, 2024, 28(8): 903-908. doi: 10.16462/j.cnki.zhjbkz.2024.08.006
引用本文: 张佩丽, 胡鹏, 郭静宜, 林华亮. 产时发热峰值及发热持续时间对母婴围产期不良结局的影响[J]. 中华疾病控制杂志, 2024, 28(8): 903-908. doi: 10.16462/j.cnki.zhjbkz.2024.08.006
ZHANG Peili, HU Peng, GUO Jingyi, LIN Hualiang. The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(8): 903-908. doi: 10.16462/j.cnki.zhjbkz.2024.08.006
Citation: ZHANG Peili, HU Peng, GUO Jingyi, LIN Hualiang. The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2024, 28(8): 903-908. doi: 10.16462/j.cnki.zhjbkz.2024.08.006

产时发热峰值及发热持续时间对母婴围产期不良结局的影响

doi: 10.16462/j.cnki.zhjbkz.2024.08.006
基金项目: 

广东省自然科学基金 2022A1515010420

国家自然科学基金 81972993

详细信息
    通讯作者:

    林华亮,E-mail : linhualiang@mail.sysu.edu.cn

  • 中图分类号: R714;R181.1

The impact of peak and duration of intrapartum fever on adverse perinatal maternal and neonatal outcomes

Funds: 

National Science Foundation of Guangdong Province, China 2022A1515010420

National Natural Science Foundation of China 81972993

More Information
  • 摘要:   目的  探讨母体产时发热体温峰值和发热持续时间对母婴围产期结局的影响。  方法  选取2020―2022年在汕头市中心医院妇产科分娩的足月单胎初产妇,以产时发热(母体体温≥37.5 ℃)为暴露因素,分别以发热峰值Tmax(产时能记录到的最高体温)、发热持续时间t(从首次记录发热到首次记录正常体温或分娩为止的时间),发热复合变量$\[v\left[ {v = \frac{{{T_{max}} - 37℃}}{{100}} \times t} \right]\]$分组。比较新生儿围产期不良结局(包括新生儿窒息、新生儿感染、缺血缺氧性脑病、惊厥、颅内出血等)和孕产妇围产期不良结局(包括母体手术产、产后出血、手术切口感染、产褥期败血症)差异。采用多因素logistic回归分析模型分析母体产时发热峰值及发热持续时间与母婴围产期不良结局之间的关联。  结果  本研究共纳入2197例研究对象,其中307名(13.9%)产妇在分娩期间出现发热。与非发热组相比,发热组新生儿不良结局及母体手术产发生风险升高。在调整混杂因素后,发热峰值每增加1 ℃,新生儿不良结局发生风险增加1.204倍(OR=2.204, 95% CI: 1.691~2.423),母体手术产发生风险增加88.3%(OR=1.883, 95% CI: 1.581~2.242);发热持续时间每增加60 min,新生儿不良结局发生风险增加28.4%(OR=1.284, 95% CI: 1.178~1.400),母体手术产发生风险增加29.4%(OR=1.294, 95% CI: 1.183~1.414);发热复合变量每增加1个单位,新生儿不良结局发生风险增加55.4%(OR=1.554, 95% CI: 1.359~1.777),母体手术产发生风险增加49.4%(OR=1.494, 95% CI: 1.298~1.720)。  结论  随着发热峰值的升高,发热持续时间增加,发热复合变量增加,新生儿不良结局及母体手术产发生风险均增加。
  • 表  1  发热组与非发热组母婴临床资料比较

    Table  1.   Comparison of maternal and neonatal clinical data between febrile group and afebrile group

    变量Variable 发热组Febrile group (n=307) 非发热组Afebrile group (n=1 890) χ2/t值value P值value
    年龄/岁Age/years 28.18±3.53 27.80±3.69 -1.644 0.100
    孕周/周Gestational age /weeks 39.60±1.03 39.34±1.05 -4.061 <0.001
    分娩镇痛Epidural analgesia 261(85.02) 1 038(54.92) 98.981 <0.001
    胎膜早破Premature rupture of membranes 161(52.44) 721(38.15) 22.459 <0.001
    生殖道GBS检测阳性GBS-positive 31(10.10) 175(9.26) 0.219 0.640
    妊娠期糖尿病Gestational diabetes mellitus 68(22.15) 345(18.25) 2.626 0.105
    妊娠期高血压疾病Hypertensive disorders of pregnancy 28(9.12) 164(8.70) 0.065 0.799
    男胎Male fetus 171(55.70) 937(49.60) 3.962 0.047
    新生儿体重Neonatal birthweight /kg 3.26±0.35 3.09±0.38 -7.804 <0.001
    新生儿头围Neonatal head circumference /cm 33.43±1.25 33.06±1.27 -4.753 <0.001
    羊水粪染Meconium-stained amniotic fluid 97(31.60) 355(18.78) 26.534 <0.001
    注:GBS,生殖道B族链球菌。
    ①以人数(占比/%)或x±s表示。
    Note: GBS, Group B streptococcus.
    ① Number of people (proportion/%) or x±s.
    下载: 导出CSV

    表  2  发热组与非发热组母婴不良结局差异

    Table  2.   Differences in adverse maternal and neonatal outcomes between the febrile and afebrile groups

    变量Variable 发热组Febrile group (n=307) 非发热组Afebrile group (n=1 890) χ2/t值value P值value
    新生儿缺血缺氧脑病Neonatal hypoxic-ischemic encephalopathy 3(1.00) 24(1.30) 0.023 0.879
    新生儿肺炎Neonatal pneumonia 18(5.86) 60(3.17) 5.575 0.018
    新生儿非典型感染Neonatal uncharacterized infection 87(28.33) 204(10.79) 70.750 <0.001
    新生儿窒息Neonatal asphyxia 8(2.61) 26(1.40) 1.878 0.171
    新生儿败血症Neonatal septicemia 1(0.33) 3(0.16) 0.000 1.000
    新生儿坏死性小肠结肠炎Neonatal necrotizing enterocolitis 1(0.33) 2(0.11) 0.018 0.893
    新生儿颅内出血Neonatal intracranial hemorrhage 9(2.93) 58(3.07) 0.017 0.897
    新生儿惊厥Neonatal seizures 0(0) 2(0.11) 0.000 1.000
    新生儿不良结局Adverse neonatal outcome 114(37.13) 311(16.46) 72.380 <0.001
    产后出血Postpartum hemorrhage 30(9.77) 179(9.47) 0.028 0.868
    手术产Maternal operative delivery 169(55.04) 515(27.24) 95.199 <0.001
    产褥期败血症Puerperal sepsis 2(0.65) 1(0.05) 3.244 0.072
    母体切口感染Maternal incision infection 5(1.63) 10(0.53) 3.227 0.072
    注:①以人数(占比/%)表示。
    Note: ① Number of people (proportion/%).
    下载: 导出CSV

    表  3  发热峰值、发热持续时间和发热复合变量与新生儿不良结局发生风险的关系

    Table  3.   Association of peak fever, duration of fever, and composite variables of fever with the risk of adverse neonatal outcomes

    发热变量Variables of fever 人数Number of people 病例数Number of cases OR值value (95% CI) P值value OR值value (95% CI) P值value
    发热峰值Peak fever/℃
      无发热Afebrile 1 890 311 1.000 1.000
      37.5 ~<38.0 183 53 2.070(1.471~2.913) <0.001 1.820(1.275~2.599) 0.001
      38.0~<38.5 90 40 4.062(2.634~6.264) <0.001 3.441(2.187~5.414) <0.001
      38.5~<39.0 24 16 10.154(4.308~23.933) <0.001 8.498(3.483~20.732) <0.001
      ≥39.0 10 5 5.077(1.461~17.642) 0.011 4.765(1.297~17.512) 0.019
      每升高1 ℃ For every 1 ℃ increase 2.207(1.857~2.624) <0.001 2.204(1.691~2.423) <0.001
    发热持续时间Duration of fever /min
      无发热Afebrile 1 890 311 1.000 1.000
      0~<60 101 30 2.145(1.376~3.344) 0.001 1.903(1.198~3.020) 0.006
      60~<120 83 39 4.500(2.876~7.043) <0.001 3.760(2.352~6.011) <0.001
      120~<180 42 14 2.539(1.321~4.877) 0.005 1.956(0.992~3.858) 0.053
      ≥180 81 31 3.148(1.979~5.008) <0.001 2.962(1.825~4.807) <0.001
      每升高60 min For every 60-minute increase 1.325(1.217~1.442) <0.001 1.284(1.178~1.400) <0.001
    发热复合变量Composite variables of fever
      无发热Afebrile 1 890 311 1.000 1.000
      0~<0.438 76 24 2.343(1.423~3.859) 0.001 2.057(1.223~3.461) 0.007
      0.438~<0.833 77 25 2.441(1.492~3.993) <0.001 2.167(1.297~3.621) 0.003
      0.833~<1.960 78 30 3.173(1.979~5.088) <0.001 2.632(1.604~4.316) <0.001
      ≥1.960 76 35 4.334(2.717~6.915) <0.001 3.815(2.344~6.210) <0.001
      每增加1个单位For every 1 unit increase 1.625(1.423~1.855) <0.001 1.554(1.359~1.777) <0.001
    注:①调整孕周、年龄、分娩镇痛、胎膜早破、新生儿体重、头围、羊水粪染。
    Note: ① Models were adjusted by gestational week, age, epidural analgesia, premature rupture of membranes, neonatal birthweight, neonatal head circumference, meconium-stained amniotic fluid.
    下载: 导出CSV

    表  4  发热峰值、发热持续时间和发热复合变量与母体手术产发生风险的关系

    Table  4.   Association of peak fever, duration of fever, and composite variables of fever with the risk of maternal operative delivery

    发热变量Variables of fever 人数Number of people 病例数Number of cases OR值value (95% CI) P值value OR值value (95% CI) P值value
    发热峰值Peak fever/℃
      无发热Afebrile 1 890 515 1.000 1.000
      37.5~<38.0 183 98 3.078(2.263~4.187) <0.001 2.754(1.982~3.827) <0.001
      38.0~<38.5 90 49 3.191(2.082~4.891) <0.001 2.577(1.639~4.053) <0.001
      38.5~<39.0 24 17 6.484(2.673~15.727) <0.001 5.227(2.103~12.991) <0.001
      ≥39.0 10 5 2.670(0.770~9.261) 0.122 2.291(0.633~8.284) 0.206
      每升高1 ℃ For every 1 ℃ increase 2.175(1.838~2.573) <0.001 1.883(1.581~2.242) <0.001
    发热持续时间Duration of fever/min
      无发热Afebrile 1 890 515 1.000 1.000
      0~<60 101 49 2.516(1.681~3.765) <0.001 2.197(1.430~3.376) <0.001
      60~<120 83 53 4.717(2.980~7.465) <0.001 4.032(2.495~6.518) <0.001
      20~<180 42 20 2.427(1.314~4.485) 0.005 1.886(0.996~3.573) 0.052
      ≥180 81 47 3.691(2.347~5.804) <0.001 3.307(2.048~5.340) <0.001
      每升高60 min For every 60-minute increase 1.374(1.256~1.503) <0.001 1.294(1.183~1.414) <0.001
    发热复合变量Composite variables of fever
      无发热Afebrile 1 890 515 1.000 1.000
      0~<0.438 76 36 2.403(1.515~3.812) <0.001 2.038(1.246~3.333) 0.005
      0.438~<0.833 77 47 4.183(2.617~6.686) <0.001 3.965(2.431~6.468) <0.001
      0.833~<1.960 78 41 2.959(1.876~4.667) <0.001 2.375(1.468~3.842) <0.001
      ≥1.960 76 45 3.876(2.426~6.192) <0.001 3.265(1.992~5.353) <0.001
      每增加1个单位For every 1 unit increase 1.631(1.417~1.877) <0.001 1.494(1.298~1.720) <0.001
    注:①调整孕周、年龄、分娩镇痛、胎膜早破、新生儿体重、头围、羊水粪染。
    Note: ① Models were adjusted by gestational week, age, epidural analgesia, premature rupture of membranes, neonatal birthweight, neonatal head circumference, meconium-stained amniotic fluid.
    下载: 导出CSV
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  • 收稿日期:  2024-01-05
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  • 刊出日期:  2024-08-10

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