严重的子宫切口感染伴盆腔脓肿的高危因素及临床治疗分析

Analysis of high risk factors and clinical treatment of severe uterine incision infection with pelvic abscess

目的探讨剖宫产术后发生严重子宫切口感染及盆腔脓肿的高危因素及临床治疗策略。方法回顾性分析2015年1月至2018年12月在宁波市妇女儿童医院行剖宫产分娩的术后发生严重子宫切口感染及盆腔脓肿的27例产妇作为观察组,按照1∶4比例随机抽取同期108例未发生上述并发症的产妇作为对照组;以分娩年龄、分娩时体质量指数、妊娠期合并症及并发症等18个因素作为观察指标。结果应用单因素条件logistic回归分析显示,两组的绒毛膜羊膜炎、胎膜早破、早产3个变量因素比较,差异有统计学意义(P<0.05);而后进行多因素条件logistic逐步回归分析,发现早产(OR=4.83)、绒毛膜羊膜炎(OR=47.8)是发生严重盆腔脓肿的高危因素。结论绒毛膜羊膜炎、早产是剖宫产术后严重子宫切口感染及盆腔脓肿的高危因素,术后发热、下腹部压痛、肠梗阻、腹壁切口愈合不良是严重盆腔感染的早期症状。术后应积极抗感染,必要时需穿刺引流或手术治疗。

Objective To explore the high risk factors and clinical treatment strategies of patients with severe uterine incision infection and pelvic abscess after cesarean section.Methods The cases of cesarean section in our hospital from January 2015 to December 2018 were analyzed retrospectively.Twenty-seven cases of severe uterine incision infection and pelvic abscess after operation were taken as the observation group,and 108 cases without the above complications were randomly selected as the control group according to the ratio of 1∶4.Eighteen factors,such as delivery age,body mass index at delivery,complications and complications during pregnancy,were used as observation indexes.Results Univariate logistic regression analysis showed that there was a significantly chorioamnionitis,premature rupture of membranes and premature delivery between the two groups(P<0.05).The multivariate logistic stepwise regression analysis showed that premature delivery(OR=4.83)and chorioamnionitis(OR=47.80)were the high risk factors for severe pelvic abscess.Conclusion Chorionic amnionitis and premature delivery are the high risk factors of severe uterine incision infection and pelvic abscess after cesarean section.Postoperative fever,lower abdominal tenderness,intestinal obstruction and poor healing of abdominal incision are the early symptoms of severe pelvic infection.After the operation,positive anti-infection should be done,and puncture and drainage or surgical treatment should be needed if necessary.