剖宫产手术腹部切口愈合不良的相关因素分析

Related factors for poor incision healing of cesarean section

目的分析剖宫产手术腹部切口愈合不良的相关因素,为预防提供依据。方法对医院2015年1月1日-2017年12月31日单胎正常产妇实施剖宫产手术者1682例的腹部切口愈合情况进行回顾性分析,比较切口愈合不良组47例(病例组)、切口甲级愈合组1635例(对照组)的相关因素,进一步分析腹部切口愈合不良患者中脂肪液化和切口感染的相关因素。结果切口愈合不良47例,发生率为2.79%,其中脂肪液化26例,切口感染17例,其他4例。与对照组比较,病例组中初产妇、肥胖者、紧急剖宫产、胎膜破裂及破裂时间>12h、手术时间>1h、失血量>1000ml、新手医生实施手术者所占比例高(P<0.05)。脂肪液化组年龄>35岁,BMI>30的产妇比例较大,而且新手医生更容易发生;切口感染组紧急剖宫产、胎膜破裂>12h者比例较大(P<0.05)。结论脂肪液化是腹部切口愈合不良的主要类型,临床医生应针对相关因素采取相应的预防措施,减少切口愈合不良的发生。

OBJECTIVE To investigate the related factors for poor healing of cesarean section sites so as to provide guidance for prevention of the poor healing.METHODS A total of 1682 single-birth puerpera who underwent cesarean section in the hospital from Jan 1,2015 to Dec 31,2017 were enrolled in the study,the status of abdominal incision healing of the enrolled puerpera was retrospectively analyzed.47 puerpera who had poor healing of incision were assigned as the case group,and 1635 puerpera who had grade A incision healing were set as the control group.The related factors for fat liquefaction and incision infection in the patients with poor incision healing were further observed.RESULTS Totally 47（2.79%）cases had poor incision healing,26 of whom had liquefaction,17 had incision infection,and 4 had others.The proportion of the puerpera who were primipara,had obesity,underwent emergency cesarean section,were with the time of rupture of fetal membranes and rupture more than 12 hours,operation duration more than 1 hour,blood loss volume more than 1000 ml or were performed by rookie doctors was higher in the case group than in the control group.The proportion of the puerpera with more than 35 years of age or BMI more than 30 was higher in the fat liquefaction group,and the fat liquefaction was more likely to be caused by rookie doctors.The proportion of the puerpera who underwent the emergency cesarean section or were with the time of rupture of membranes more than 12 hours was higher in the incision infection group（P〈0.05）.CONCLUSIONThe fat liquefaction is the major type of poor incision healing.It is necessary for clinicians to take targeted prevention measures according to the related factors so as to reduce the incidence of the poor incision healing.