会阴侧切连续缝合与间断缝合效果及切口感染危险因素分析

Effect of the discontinuous or continuous suture of the incision after lateral perineotomy of puerperas and the analysis of the risk factors of the incisional infection of the puerperas

目的:分析会阴侧切连续缝合与间断缝合效果及切口感染危险因素。方法:回顾性收集2021年1月-2023年1月在本院顺产且行会阴侧切的产妇78例临床资料,按照术中缝合方式不同分为连续组(n=40)与间断组(n=38),对比两组术中出血量及缝合时间,术后恢复效果包括愈合时间、切口愈合情况、伤口疼痛程度,产后不良反应及切口感染情况;单因素、多因素分析引发产妇切口感染的危险因素。结果:连续组术中出血量(20.2±3.2ml)及术中缝合时间(14.9±2.1min)均低于间断组(31.3±4.4ml、20.8±2.3min),术后的切口愈合情况优于间断组,切口愈合时间(5.53±1.69d)、疼痛时间(2.33±0.76d)及术后第三天疼痛VAS评分(2.35±1.10分)均低于间断组(6.87±1.47d、2.95±0.80d、3.55±1.91分),术后不良反应发生率(12.5%)低于间断组(36.8%);多因素分析显示,出血量多、阴道检查次数多、产程长及胎膜早破是影响产妇发生切口感染的独立危险因素(均P<0.05)。结论:对于会阴侧切产妇应用连续缝合能够有效促进术后切口恢复、降低不良反应发生情况。出血量多、多次阴道检查、产程长及胎膜早破为引发切口感染的独立危险因素,临床应密切关注该类产妇,以降低切口感染发生。

Objective:To explore the effect of the discontinuous or continuous suture of the incision after lateral perineotomy of puerperas,and to analyze of the risk factors of the incisional infection of the puerperas.Methods:The clinical data of 78puerperas who had undergone lateral perineotomy during vaginal delivery from January 2021to January 2023 were collected retrospectively.These puerperas were divided into 40puerperas with the continuous suture of the incision after the lateral perineotomy in group A and 38puerperas with the discontinuous suture of the incision in group B according to different methods of intraoperative suture of the incision.The amount of intraoperative blood loss and the suture duration,the efficacy of postoperative recovery,such as healing time,incision healing,and wound pain,and the incidences of the postpartum adverse reactions and the incision infection of the puerperas were compared between the two groups.Univariate and multivariate analysis was used to explore the independent risk factors of the maternal incision infection.Results:The intraoperative blood loss(20.2±3.2ml)and the duration of intraoperative suture of the incision(14.9±2.1min)of the puerperas in group A were significantly lower than those(31.3±4.4ml and 20.8±2.3 min)of the puerperas in group B.The postoperative wound healing situation of the puerperas in group A was significantly better than that of the puerperas in group B.The incision healing time(5.53±1.69d),the pain time(2.33±0.76 d),and the VAS score on the third day after operation(2.35±1.10points)of the puerperas in group A were significantly lower than those(6.87±1.47d,2.95±0.80d,and 3.55±1.91points)of the puerperas in group B.The incidence of postoperative adverse reactions(12.5%)of the puerperas in group A was significantly lower than that(36.8%)of the puerperas in group B.Multivariate analysis showed that the more bleeding,the more times of vaginal examination,the longer labor time,and the premature rupture of membranes of the puerperas were the independent risk factors of the maternal incision infection(all P<0.05).Conclusion:For the puerperas with lateral perineotomy,the continuous suture of the incision can effectively promote their postoperative incisional healing,and reduce their occurrence of adverse reactions.The more blood loss and vaginal examinations,the longer labor stage,and the premature rupture of membranes of the puerperas are the independent risk factors of their incisional infection,and the paying close attention to these puerperas should be conducted in clinic so as to reduce their incidence of incisional infection.