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产时发热

Author
Katherine T Chen, MD, MPH
Section Editors
Susan M Ramin, MD
David L Hepner, MD
Deputy Editor
Vanessa A Barss, MD, FACOG
Translators
陈海天, 主治医师

引言

产时发热(即临产时发热)可由感染性或非感染性病因引起，并可导致多种母体和新生儿后遗症。已报道多个产时发热的危险因素，如未经产、滞产和胎膜早破[1]。这些特征说明女性有可能发生羊膜腔内感染(intraamniotic infection, IAI)和/或接受硬膜外麻醉，这是产时发热的两个常见原因。没有先前就存在的发热性疾病(如呼吸系统感染)的情况下，大多数在临产时出现发热的妊娠女性被假定发生了IAI并使用广谱抗生素来治疗。

机制

绝大多数体温上升的患者都会发热，当特定的宿主细胞对感染、炎症、损伤或抗原攻击做出应答时会产生“内源性致热源”，这种致热源可使下丘脑体温调节中枢重新设定调定点至更高的温度。这些致热性多肽包括细胞因子白细胞介素(interleukin, IL)-1α和IL-1β、IL-6、肿瘤坏死因子(tumor necrosis factor, TNF)-α和TNF-β、以及干扰素-α[2,3]。

在少数病例中，体温上升表示的是过热而不是发热。例如，一些具有药理作用的制剂(如阿托品、消遣性药物“摇头丸”)会通过抑制发汗或抑制血管舒张从而提升核心温度，而不改变正常的下丘脑调定点。 (参见“成人发热的病理生理学和治疗”和“药物热”)

本专题中，出于讨论目的，将术语“发热”用于描述由任何机制导致的母体产时体温升高。

定义

发热定义为体温上升超出正常日常变化。产时发热的阈值一般认为是母体口腔温度大于等于38℃(≥100.4℉)。这一结果部分是基于一项关于正常产妇的体温的研究得出的，该研究中正常产妇在进入产房时的体温介于34.6-37.6℃(94.3-99.7℉)[4]。体温的昼夜规律为午夜至凌晨2点为高峰，早上11点至正午为最低点。

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-06.
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