阴道试产失败中转剖宫产术前碘伏冲洗阴道+术中碘伏及甲硝唑冲洗宫腔预防术口愈合不良的效果

Effect of preoperative vaginal irrigation with iodophor + intraoperative uterine cavity irrigation with iodophor and metronidazole to prevent poor healing of the surgical incision in pregnant women converted to cesarean section due to failed vaginal trial

目的 研究阴道试产失败中转剖宫产术前碘伏冲洗阴道+术中碘伏及甲硝唑冲洗宫腔的效果。方法 90例阴道试产失败中转剖宫产产妇作为研究对象,根据消毒方式不同分为A组、B组和C组,每组30例。A组采用抗生素+术前应用0.5%碘伏液冲洗阴道+术中用0.5%碘伏及2%甲硝唑注射液冲洗宫腔, B组采用抗生素+术中用0.5%碘伏及2%甲硝唑注射液冲洗宫腔, C组采用抗生素+术中用2%甲硝唑注射液冲洗宫腔。比较三组术后24 h体温、白细胞计数(WBC)、C反应蛋白(CRP)水平及术后切口感染率。结果 A组术后24 h体温、WBC、CRP分别为(37.15±0.23)℃、(10.13±0.51)×109/L、(15.61±1.18)mg/L, B组分别为(37.69±0.28)℃、(11.42±0.56)×109/L、(17.02±1.21)mg/L,C组分别为(38.42±0.62)℃、(12.61±0.59)×109/L、(18.72±1.29)mg/L;三组术后24 h体温、WBC、CRP水平比较差异有统计学意义(P<0.05);A组术后24 h体温、WBC、CRP水平均明显低于B组与C组,且B组均低于C组,差异有统计学意义(P<0.05)。A组、B组、C组术后切口感染率分别为3.33%、10.00%、13.33%,三组比较差异无统计学意义(P>0.05);A组术后切口感染率低于B组、C组,且B组低于C组,但组间两两比较差异无统计学意义(P>0.05)。结论 对阴道试产失败中转剖宫产的产妇,选择抗生素+术前应用0.5%碘伏液冲洗阴道+术中用0.5%碘伏及2%甲硝唑注射液冲洗宫腔的方法可更有效控制术后产妇体温水平以及实验室指标水平,对术后感染的发生有控制作用,值得临床推广应用。

Objective To study the effect of preoperative vaginal irrigation with iodophor + intraoperative uterine cavity irrigation with iodophor and metronidazole to prevent poor healing of the surgical incision in cesarean section women with a failed trial of labor. Methods A total of 90 pregnant women converted to cesarean section due to failed vaginal trial of labor as the study subjects were divided into group A, group B and group C according to the different disinfection methods, with 30 cases in each group. Group A used antibiotics +preoperative vaginal irrigation with 0.5% iodophor + intraoperative uterine cavity irrigation with 0.5% iodophor and 2% metronidazole injection, group B used antibiotics + intraoperative uterine cavity irrigation with 0.5%iodophor and 2% metronidazole injection, and group C used antibiotics + intraoperative uterine cavity irrigation with 2% metronidazole injection. The body temperature, white blood cell count(WBC), C-reactive protein(CRP)levels at 24 h postoperatively, and postoperative incisional infection rate were compared among the three groups.Results At 24 h postoperatively, the body temperature, WBC, and CRP in group A were(37.15±0.23)℃,(10.13±0.51)×109/L, and(15.61±1.18)mg/L, while those in group B were(37.69±0.28)℃,(11.42±0.56)×109/L, and(17.02±1.21)mg/L, and in group C were(38.42±0.62)℃,(12.61±0.59)×109/L, and(18.72±1.29)mg/L. The differences in body temperature, WBC and CRP levels at 24 h postoperatively were statistically significant among the three groups(P<0.05). At 24 h postoperatively, the body temperature, WBC and CRP in group A were significantly lower than those in group B and group C, and group B were lower than group C. The differences were statistically significant(P<0.05). The postoperative incisional infection rates in group A, group B and group C were 3.33%, 10.00% and 13.33%, and the differences among the three groups were not statistically significant(P>0.05). The postoperative incisional infection rate in group A was lower than that in group B and group C, and group B was lower than group C, but the difference among the two groups was not statistically significant(P>0.05). Conclusion For pregnant women converted to cesarean section due to failed vaginal trial of labor, the method of antibiotics + preoperative vaginal irrigation with 0.5% iodophor + intraoperative uterine cavity irrigation with 0.5% iodophor and 2% metronidazole injection can more effectively control the postoperative maternal temperature level and laboratory index level, and has a good control effect on the occurrence of postoperative infection, which is worthy of clinical promotion and application.