妊娠期糖尿病产妇会阴侧切切口感染危险因素及与疼痛评分关系

Risk factors of incision infection after lateral perineotomy of pregnant women with gestational diabetes mellitus and the correlation with pain score

目的:分析引发妊娠期糖尿病(GDM)孕产妇会阴侧切后切口感染危险因素及与疼痛关系。方法:回顾性收集2020年1月-2022年12月在本院顺产行会阴侧切GDM产妇,发生切口感染10例纳入观察组,未发生切口感染51例纳入对照组;单因素、多因素分析引发GDM产妇侧切后发生切口感染的独立危险因素;采用视觉模拟疼痛量表(NRS)观察两产前及产后3天疼痛程度;分析本研究中引发GDM产妇侧切后感染的危险因素与疼痛评分关系,并采用Spearman相关系数验证相关性。结果:单因素、多因素分析显示,第二产程长、急诊分娩、胎膜早破、羊水污染是影响GDM产妇发生切口感染的独立危险因素,而血糖控制达标、抗生素药物应用及侧切为连续缝合方式是保护因素(均P<0.05);经Spearman相关系数分析显示,胎膜早破、第二产程(≥3h)、羊水污染与GDM产妇产后疼痛呈正相关,而血糖控制达标、应用抗生素药物及侧切后连续缝合与GDM产妇产后疼痛呈负相关(均P<0.05)。结论:第二产程长、急诊分娩、胎膜早破、血糖控制达标、抗生素药物应用及侧切缝合方式等均是影响GDM产妇发生侧切切口感染的相关因素,且会影响产后会阴疼痛,针对以上因素制定预防措施对预防切口感染及降低产后会因疼痛程度有重要临床意义。

Objective:To analyze the risk factors of incision infection after lateral perineotomy during delivery of preg-nant women with gestational diabetes mellitus(GDM),and to study the correlation between the infective risk factors of the women and their pain score.Methods:A retrospective analysis was used to cllct the clinical data of 10 preg-nant women with GDM and perineotomy incision infection(in observation group)from January 2020 to December 2022,and 51 women with GDM but without episiotomy incision infection during the same period were selected in con-trol group.Univariate and multivariate analysis were used to analyze the independent risk factors of the incision infec-tion after lateral episiotomy of the women with GDM.The visual analogue scale(NRS)was used to observe the pain degree of the women in the two groups before and in 3 days after delivery.The correlation betwecn the risk factors of infection after incision of the women and their pain score was analyzed,and the correlation was verified by Spearman correlation coefficient.Results:Univariate and multifactorial analyses showed that the longer second stage of labor,the emergency delivery.the premature rupture of membrancs,and the amniotic fluid contamination of the women were the independent risk factors of their incision infection,while the glycemic control status reached to the standard,the appli-cation of antimicrobial drugs,and the continuous suture of incision of the women were the protective factors of their in-cision infection(all P<0.05).Spearman's correlation cofficient analysis showed that the premature rupture of mem-branes,the duration of second stage of labor≥3h,and the amniotic fluid contamination of the women with GDM were significantly positively correlated with their postpartum pain,but the glycemic control status reached to the standard,the application of antimicrobial drugs,and the continwous suture of incision of the women with GDM were sigificantly negatively correlated with their postpartum pain(all P<0.05).Conclusion:The longer second stage of labor,the e mergency delivery.the premature rupture of membranes,the glycemic control status reached to the standard,the ap-plication of antimicrobial drugs,and the suture mode of incision of the women with GDM are all the related factors of their incision infection after lateral episiotomy,which will afect the postpartum perineal pain,so based on these fac-tors,it is of great clinical significance to develop the preventive measures to reduce the incision infection and decrease the postpartum perineal pain degree.