产妇分娩期发热与镁应用的关系：回顾性横断面研究
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Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study
背景与目
产妇分娩期发热与一些新生儿不良结局有关。发热原因可能是感染或是炎症。白介素6和其他炎性标志物的增加与产妇的发热有关。动物研究证实，镁可减轻白介素6介导的发热。我们假设产妇分娩期镁的使用可降低发热发生生率。
方 法
本研究评估了2007〜2014年西北纪念医院（芝加哥）所有产妇的电子病历数据。主要结局指标是分娩期发热（体温38.0℃以上）。多变量逻辑回归模型评估产妇发热的相关因素。使用倾向得分匹配减少非随机镁应用所导致的潜在偏倚
结 果
58541名产妇符合纳入标准，5924（10.1％）名产妇发生了分娩期发热。初产妇、椎管内镇痛和剖腹产产妇更可能发生分娩期发热。镁应用产妇（6.0％）发热发生率低于那些未应用的（10.2％）。多变量逻辑回归分析，镁暴露的产妇发热可能性更低（调整比值比= 0.42 [95％CI，0.31〜0.58]）。倾向匹配（N = 959 /组）后，镁治疗产妇发热的比值比较低（比值比= 0.68 [95％CI，0.48〜0.98]）。
结 论
镁可能减轻产妇分娩期发热，应进一步探索镁的剂量与产妇发热的关系。
原始文献摘要
Lange EMS, Segal S, Pancaro C, et al. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study[J]. Anesthesiology, 2017, doi: 10.1097/ALN.0000000000001872. [Epub ahead of print]
BACKGROUND:Intrapartum maternal fever is associated with several adverse neonatal outcomes. Intrapartum fever can be infectious or inflammatory in etiology. Increases in interleukin 6 and other inflammatory markers are associated with maternal fever. Magnesium has been shown to attenuate interleukin 6-mediated fever in animal models. We hypothesized that parturients exposed to intrapartum magnesium would have a lower incidence of fever than nonexposed parturients.
METHODS:In this study, electronic medical record data from all deliveries at Northwestern Memorial Hospital (Chicago, Illinois) between 2007 and 2014 were evaluated. The primary outcome was intrapartum fever (temperature at or higher than 38.0°C). Factors associated with the development of maternal fever were evaluated using a multivariable logistic regression model. Propensity score matching was used to reduce potential bias from nonrandom selection of magnesium administration.
RESULTS:Of the 58,541 women who met inclusion criteria, 5,924 (10.1%) developed intrapartum fever. Febrile parturients were more likely to be nulliparous, have used neuraxial analgesia, and have been delivered via cesarean section. The incidence of fever was lower in women exposed to magnesium (6.0%) than those who were not (10.2%). In multivariable logistic regression, women exposed to magnesium were less likely to develop a fever (adjusted odds ratio = 0.42 [95% CI, 0.31 to 0.58]). After propensity matching (N = 959 per group), the odds ratio of developing fever was lower in women who received magnesium therapy (odds ratio = 0.68 [95% CI, 0.48 to 0.98]).
CONCLUSIONS:Magnesium may play a protective role against the development of intrapartum fever. Future work should further explore the association between magnesium dosing and the incidence of maternal fever.
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