剖宫产术后腹壁切口愈合不良的原因分析并干预对策

Reason analysis and intervention measures for poor healing of abdominal wall incision after cesarean section

目的探讨剖宫产术后腹壁切口愈合不良的原因，并据此提出干预对策，促进切口愈合。方法回顾性分析本院妇产科2011-2012年剖宫产腹壁切口呈乙、丙级愈合的45例产妇资料。其中切口全部裂开11例，部分裂开34例；切口感染致愈合不良19例、脂肪液化21例、脂肪液化并感染5例，病例予术后拆线、局部清创、抗炎、二期缝合、神灯理疗、对症护理等综合处置，并探讨切口愈合不良的影响因素。针对性提出护理干预措施。结果①本院产科2年问剖宫产术后切口愈合不良发生率2．6％，平均愈合时间（14．2±4．7）d。②切口愈合不良的影响因素涉及致病菌因素、手术操作因素与产妇体质因素。结论加强孕期保健与术前评估、规范术前准备与助产操作、预防性使用抗生素、强化术后基础护理与切口保护是减少剖宫产术后腹壁切口愈合不良的有效措施。

Objective To discuss the causes of poor healing of abdominal wall incision after cesarean section, then accordingly put forward the intervention measures, to promote the healing. Methods Retrospective analysis the data of the 45 cases of puerperae who were received in the obsterics and gynecology department in our hospital during the period from 2011 to 2012 and their cesarean section incision healing grade were in grade B, C. Among of which, 11 cases got the incision completely dehiscence, 34 cases got partially dehiscence, 19 cases got infection of incision to cause the poor healing, 21 cases got the fat liquefaction, 5 cases got infection complicated by fat liquefaction, all the cases had the take out stitches surgrey, the local debridement, anti-inflammatory therapy, the secondary suture, TDP lamp, physical therapy and symptomatic nursing and such comprehensive treatment, and discuss the influence factors of poor healing of incision, specifically raised the nursing intervention measures. Results ①The incision poor healing rate after the cesarean section was 2.6% in the obstetrics department of our hospital during the two years, and the mean healing time was（14.2±4.7）d.②The influence factors of the incision poor healing refered to bacterial condition pathogenic factors, the operational factors and factors of physipue. Conclusion To strengthen the pregnancy health care and preoperative evaluation, standard the preoperative preparation and the operation of aids to delivery, the preventive use of antibiotics, strengthen the basic nuring and postoperative incision protection would be necessary and effective measures to reduce the poor healing of abdominal wall incision after cesarean section.