剖宫产术中不同温度甲硝唑溶液冲洗宫腔对产后感染的影响

Influence of flushing of uterine cavity with metronidazole solution at different temperatures on postpartum infection of puerpera undergoing cesarean section

目的 探讨剖宫产术中不同温度甲硝唑溶液冲洗宫腔对产后感染的影响。方法 选择2012年10月-2017年10月医院进行剖宫产手术的高危产妇120例为研究对象,按照产妇在剖宫产手术中不同的宫腔冲洗溶液分为A,B,C,D四个组,每组30例。A组产妇使用温度为22~25℃的甲硝唑溶液进行宫腔冲洗,B组产妇使用温度为39~40℃的甲硝唑溶液冲洗,C组产妇使用温度为37.5~37.8℃的甲硝唑溶液进行冲洗,D组产妇使用室温的生理盐水进行冲洗,观察和记录产妇术中及术后指标的差异。结果 四组产妇产后发热时间,排气时间,下床时间,完成手术后2h阴道出血量比较差异有统计学意义(P<0.05),而且均为D组的数值高于A组和B组,A组和B组的数值高于C组;四组产妇切口感染率比较差异无统计学意义,宫腔感染与产褥病比较差异有统计学意义(P<0.05),在两两比较中,C组产妇的产褥病发生率最低,完成手术后,A组与D组产妇的体温出现了降低(P<0.05),B组与C组产妇的体温并未出现明显变化,心率均出现了上升(P<0.05),其中A组与D组产妇的心率高于B组与C组产妇。结论 利用温度在37.5~37.8℃的甲硝唑溶液冲洗宫腔,可以减少产后发热时间,有效预防宫腔感染与产褥热的发生,对产妇的生命体征影响不明显,有利于产妇的康复,值得在临床范围内推广。

OBJECTIVE To explore the influence of flushing of uterine cavity with metronidazole solution at different temperatures on postpartum infection of puerpera undergoing cesarean section.METHODS A total of 120highrisk puerpera who received cesarean section in the hospital from Oct 2012to Oct 2017were recruited as the study objects and divided into the group A,B,C and D according to the different temperatures of solution for flushing of uterine cavity,with 30cases in each group.The group A was treated with the metronidazole solution with the temperature ranging between 22and 25℃,the group B was treated with the metronidazole solution with the temperature ranging between 39and 40℃,the group C was treated with the metronidazole solution with the temperature ranging between 37.5and 37.8℃,and the group D was treated with the indoor temperature of normal saline.The intraoperative and postoperative indexes of the puerpera were recorded and observed.RESULTS There were significant differences in the time of postpartum fever,exhaust and off bed as well as vaginal bleeding volume 2hours after the surgery among the four groups(P<0.05);the values of the above indexes of the group D were higher than those of the group A and B,and the values of the above indexes of the group A and B were higher than those of the group C.There was no significant difference in the incidence of incision infection among the four groups of puerpera, there were significant differences in the incidence rates of intrauterine infection and puerperalism (P < 0.05).For the between-group comparation,the incidence rate of puerperalism was the lowest in the group C,the body temperatures of the puerpera were reduced in the group A and D(P<0.05);the body temperatures of the puerpera did not change in the group-B and C,the heart rates were increased(P<0.05),and the heart rates of the puerpera were higher in the group A and D than in the group B and C.CONCLUSIONThe flushing of uterine cavity with 37.5-37.8℃of metronidazole solution may shorten the postpartum fever,effectively prevent the intrauterine infection and puerperalism,have less significant impact on the vital signs of the puerpera and facilitate the rehabilitation, and it is worthy to be promoted in the hospital.