【罂粟摘要】硬膜外镇痛、分娩期高热与新生儿脑损伤：一项系统回顾和Meta分析
硬膜外镇痛、分娩期高热与新生儿脑损伤：一项系统回顾和Meta分析
贵州医科大学 高鸿教授课题组
翻译：牛振瑛 编辑：佟睿 审校：曹莹
硬膜外镇痛与分娩期体温升高有关，羊膜炎与新生儿脑损伤有关。然而，目前尚不清楚硬膜外镇痛引起的高热是否与新生儿脑损伤有关。本系统回顾和Meta分析研究了三个问题：(1)硬膜外镇痛是否导致分娩期高热；(2)分娩期高热是否与新生儿脑损伤相关；(3)硬膜外镇痛引起的高热是否与新生儿脑损伤相关？
检索PubMed、ISI Web of Knowledge、Cochrane Library和Embase，检索时间截止至2020年1月，检索词为与硬膜外镇痛、高温、分娩和新生儿脑损伤相关的医学主题词目(MESH)。由两位作者独立审查研究的纳入和质量(建议分级、评估、发展和评价(等级)方法)。采用ManteleHaenszel固定效应法进行meta分析，得出优势比（or）和95%置信区间（CIs）。
问题1(646296名参与者)包括41项研究，问题2(11866 021名参与者)包括36项研究，问题3(297113名参与者)包括2项研究。当镇痛方式随机化时，硬膜外镇痛与产时体温升高有关（OR:4.21；95%CI：3.48-5.09）。分娩期体温过高与新生儿脑损伤相关(OR：2.79；95%CI：2.54-2.3.06)。硬膜外镇痛引起的体温过高与新生儿脑损伤之间的联系无法量化。
硬膜外镇痛是产程中体温过高的原因之一，任何原因的分娩期体温过高都与新生儿脑损伤有关。硬膜外镇痛引起的体温过高是否是新生儿脑损伤的原因还需要进一步的研究。
原始文献来源：
Morton S, et al.Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis[J]. Br J Anaesth. 2021 Feb;126(2):500-515. doi: 10.1016/j.bja.2020.09.046.
Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis
Abstract
Background: Epidural analgesia is associated with intrapartum hyperthermia, and chorioamnionitis is associated with neonatal brain injury. However, it is not known if epidural hyperthermia is associated with neonatal brain injury. This systematic review and meta-analysis investigated three questions: (1) does epidural analgesia cause intrapartum hy-perthermia, (2) is intrapartum hyperthermia associated with neonatal brain injury, and (3) is epidural-induced hyper-thermia associated with neonatal brain injury?
Methods: PubMed, ISI Web of Knowledge, The Cochrane Library, and Embase were searched from inception to January 2020 using Medical Subject Headings (MeSH) terms relating to epidural analgesia, hyperthermia, labour, and neonatal brain injury. Studies were reviewed independently for inclusion and quality by two authors (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach). Two meta-analyses were performed using the ManteleHaenszel fixed effect method to generate odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Forty-one studies were included for Question 1 (646 296 participants), 36 for Question 2 (11 866 021 participants), and two studies for Question 3 (297 113 participants). When the mode of analgesia was randomised, epidural analgesia was associated with intrapartum hyperthermia (OR: 4.21; 95% CI: 3.48-5.09). There was an association between intrapartum hyperthermia and neonatal brain injury (OR: 2.79; 95% CI: 2.54-2.3.06). It was not possible to quantify the association between epidural-induced hyperthermia and neonatal brain injury.
Conclusions: Epidural analgesia is a cause of intrapartum hyperthermia, and intrapartum hyperthermia of any cause is associated with neonatal brain injury. Further work is required to establish if epidural-induced hyperthermia is a cause of neonatal brain injury.
翻译：牛振瑛
编辑：佟睿
审校：曹莹
贵州医科大学高鸿教授课题组