剖宫产术后子宫切口愈合不良的影响因素及预防  

Influencing factors of poor healing of uterine incision after cesarean section and its prevention

作　　者：万秀娟 

机构地区：[1]江苏省兴化市第五人民医院妇产科,江苏兴化225766

出　　处：《中国妇幼健康研究》2017年第12期1665-1667,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的评估剖宫产术后子宫切口愈合不良的相关影响因素,为减少剖宫产术后子宫切口愈合不良的发生及预防提供临床依据。方法选择2012年1月至2017年4月江苏省兴化市第五人民医院行剖宫产术产妇523例,其中子宫切口愈合不良产妇31例,作为观察组,子宫切口愈合良好产妇492例,作为对照组,比较两组产妇基本情况及手术状况等相关影响因素,并进行Logistic回归分析,分析其相关性。结果剖宫产术后切口愈合不良31例患者中切口感染13例,切口裂开10例,切口脂肪液化8例。观察组产妇既往剖宫产史、阴道炎宫颈炎史、合并基础疾病、胎位异常、瘢痕子宫(不包括既往剖宫产史)、急诊手术、胎膜早破、羊膜腔感染和切口感染百分比均高于对照组,差异均有统计学意义(χ~2值分别为9.84、8.90、10.26、7.88、8.05、8.39、8.17、9.48、7.96,均P<0.05)。观察组产妇体质指数(BMI)、手术时间和术中失血量均高于对照组,差异均有统计学意义(t值分别为12.43、11.90、17.52,均P<0.05)。多因素Logistic回归分析剖宫产术后子宫切口愈合不良发生率与孕前BMI(OR:1.481,95%CI:1.249~1.765)、既往剖宫产史(OR=1.512,95%CI:1.401~1.827)、合并基础疾病(OR=1.490,95%CI:1.388~1.914)、手术时间(OR=1.473,95%CI:1.390~1.876)、术中失血量(OR=1.408,95%CI:1.328~1.745)、急诊手术(OR=1.392,95%CI:1.242~1.693)、胎膜早破(OR=1.520,95%CI:1.374~1.828)、羊膜腔感染(OR=1.604,95%CI:1.329~1.746)、切口感染(OR=1.529,95%CI:1.208~1.695)相关,差异均具有统计学意义(均P<0.05)。结论剖宫产术后子宫切口愈合不良的主要影响因素有BMI、既往剖宫产史、合并基础疾病、手术时间、术中失血量、急诊手术、胎膜早破、羊膜腔感染和切口感染等,并与其相关,临床上应采取有效的预防措施以降低其发生率。Objective To assess the influencing factors of poor healing of uterine incision after cesarean section,so as to provide clinical basis for reducing and preventing poor healing of uterine incision after cesarean section.Methods A total of 532 parturient women receiving cesarean section in Fifth People＇s Hospital of Xinghua City from January 2012 to April 2017 were selected,among which 31 cases with poor healing of uterine incision were divided into observation group and 492 cases with good healing of uterine incision were divided into control group.Related factors such as basic information and operation conditions of patients in two groups were compared and their correlation was analyzed with Logistic regression analysis.Results Among 31 cases with poorly healed uterine incision,13 cases had incision infection,10 cases had incision dehiscence,and 8 cases had incision fat liquefaction.Percentages of patients who had cesarean section history,vaginitis and cervicitis history,combined underlying disease,abnormal fetal position,scarred uterus（not including history of cesarean section）,emergency surgery,premature rupture of membranes,amniotic cavity infection and infection of incisional wound in observation group were significantly higher than those in control group,and differences were statistically significant（χ~2 value was 9.84,8.90,10.26,7.88,8.05,8.39,8.17,9.48 and 7.96,respectively,all P〈0.05）.Body mass index（BMI）,duration of operation and intraoperative blood loss in observation group were significantly higher than those in control group,and differences were statistically significant（t value was 12.43,11.90 and 17.52,respectively,all P〈0.05）.Multiple factor Logistic regression analysis showed that poor healing of uterine incision after cesarean section was associated with pre-pregnancy BMI（OR：1.481,95%CI：1.249-1.765）,cesarean section history（OR：1.512,95%CI：1.401-1.827）,combined underlying disease（OR：1.490,95%CI：1.388-1.914）,duration of operation（OR：1.473,95%CI：

关 键 词：剖宫产术 子宫 愈合不良 影响因素 预防措施 

分 类 号：R719.8[医药卫生—妇产科学]