剖宫产术后腹部切口愈合不良的原因及对策
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摘要
目的探讨妇产科剖宫产术后腹部切口愈合不良的原因及对策。方法选择2016年8月～2018年8月在北京市丰台中西医结合医院妇产科行剖宫产术,且术后切口愈合不良的患者40例为观察组,同期切口愈合良好的患者779例为对照组,分析切口愈合不良的可能原因,探讨如何能够预防切口愈合不良,加速切口愈合。结果我院剖宫产术后切口愈合不良发生率为4.88%,观察组患者手术时间为夏季、宫颈分泌物培养见致病菌、胎膜早破、孕前超重或肥胖、腹壁脂肪层厚度>3 cm、试产、皮下组织内残留线结、皮下组织使用电刀止血、术后发热者比例显著高于对照组,差异有统计学意义(P<0.05)。结论影响剖宫产切口愈合不良的相关因素为手术时间为夏季、宫颈分泌物培养见致病菌、胎膜早破、孕前超重或肥胖、腹壁脂肪层厚度>3cm、试产、皮下组织内残留线结、皮下组织使用电刀止血、术后发热,应从孕期保健、术前准备、术中操作、术后管理几个方面着手预防,发现切口愈合不良后,及时敞开切口、清除坏死组织、充分引流有利于愈合。
Objective To find out the causes and countermeasures of poor healing of cesarean section in obstetrics and gynecology department. Methods From August 2016 to August 2018, 40 patients with poor wound healing who underwent cesarean section in the Department of Obstetrics and Gynecology of Fengtai Hospital of Traditional Chinese Medicine and Western Medicine were selected as observation group, 779 patients with good healing in the same period were the control group. The possible causes of poor wound healing were analyzed and how to prevent the poor wound healing and the methods for accelerating wound healing were discussed. Results The incidence of poor wound healing after cesarean section was 4.88%. In the observation group, the proportion of summer operation, pathogenic bacteria, premature rupture of membranes, overweight or obesity before pregnancy, abdominal adipose layer thickness >3 cm, trial production, residual knots in subcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation were significantly higher than those in control group(P<0.05). Conclusions Summer operation, pathogenic bacteria, premature rupture of membranes,overweight or obesity before pregnancy, abdominal adipose layer thickness >3 cm, trial production, residual knots in subcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation are the common causes of poor wound healing, which should be prevented from pregnancy care, preoperative preparation, intraoperative operation and postoperative management. When poor wound healing is found, it is important to open the incision, remove necrotic tissue,and drain sufficiently.
Objective To find out the causes and countermeasures of poor healing of cesarean section in obstetrics and gynecology department. Methods From August 2016 to August 2018, 40 patients with poor wound healing who underwent cesarean section in the Department of Obstetrics and Gynecology of Fengtai Hospital of Traditional Chinese Medicine and Western Medicine were selected as observation group, 779 patients with good healing in the same period were the control group. The possible causes of poor wound healing were analyzed and how to prevent the poor wound healing and the methods for accelerating wound healing were discussed. Results The incidence of poor wound healing after cesarean section was 4.88%. In the observation group, the proportion of summer operation, pathogenic bacteria, premature rupture of membranes, overweight or obesity before pregnancy, abdominal adipose layer thickness >3 cm, trial production, residual knots in subcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation were significantly higher than those in control group(P<0.05). Conclusions Summer operation, pathogenic bacteria, premature rupture of membranes,overweight or obesity before pregnancy, abdominal adipose layer thickness >3 cm, trial production, residual knots in subcutaneous tissue, use of electric knife in subcutaneous tissue and fever after operation are the common causes of poor wound healing, which should be prevented from pregnancy care, preoperative preparation, intraoperative operation and postoperative management. When poor wound healing is found, it is important to open the incision, remove necrotic tissue,and drain sufficiently.
引文
[1]周丹,邱慧,安晨凤,等.剖宫产术后腹壁切口愈合不良的原因分析并干预对策[J].中国现代医生,2013,51(36):90-2.
[2]唐艳琴,邢镝,陈润芳.剖宫产术后腹部切口愈合不良临床调查与分析[J].中华医院感染学杂志,2011,20(19):4028-9.
[3]赵群英.剖宫产术后腹部切口愈合不良32例分析[J].中外医疗,2010,29(31):79-82.
[4]潘秀明.剖宫产切口愈合不良的相关因素探讨及预防[J].中国实用医药,2009,4(13):45-6.
[5]魏凌云,赵一俏,何萍,等.剖宫产手术后切口愈合不良多因素分析[J].中国感染控制杂志,2004,3(2):122-4.
[6]Allami MK,Jamil W,Fourie B,et al.Superficial incisional infection in arthroplasty of the lower limb-Interobserver reliability of the current diagnostic criteria[J].J Bone Joint Surgery-British Volume,2005,87B(9):1267-71.
[7]Cui ZQ,Miao RZ.Diagnosis and treatment of fat liquefaction of abdominal incision[J].J Abdom Surg,2004,14(6):710-6.
[8]Berle P WE,Geburtshilfe UF.Maternal morbidity after abdominal cesarean section in relation to bacterial amniotic fluid colonization and premature rupture of fetal membranes[J].Geburtshilfe Und Frauenheilkunde,1991,51(9):722-6.
[9]叶林阳,林茂虎,郁华亮,等.泌尿系感染与手术切口感染相关性分析[J].中华医院感染学杂志,2007,17(12):1512-4.
[10]Vincent A,Ayzac L,Girard R,et al.Downward trends in surgical site and urinary tract infections after cesarean delivery in a French surveillance network,1997-2003[J].Infect Contr Hospital Epidemiol,2008,29(3):227-33.
[11]俞晶,杨宏英,朱娇阳,等.宫颈癌患者术后感染病原菌及耐药性分析[J].中华医院感染学杂志,2013,23(14):3535-6,3539.
[12]谭辉,伍敬柱,吴林鸿,等.腹腔镜胆囊切除术不同取胆方式切口感染分析[J].中华医院感染学杂志,2015,25(17):4003-5.
[13]刘文丽.普外科切口感染的影响因素及护理对策分析[J].医药卫生:文摘版,2016,18(8):176-8.
[14]赵砚霞,孙广美.洗手护士在手术中预防切口感染的措施[J].中华现代护理学杂志,2005,21(7):712-5.
[15]Tongyoo A,Chatthamrak P,Sriussadaporn E,et al.Risk assessment of abdominal wall thickness measured on Pre-Operative computerized tomography for incisional surgical site infection after abdominal surgery[J].J Med Assoc Thai,2015,98(7):677-83.
[16]Kwaan MR,Sirany AM,Rothenberger DA.Abdominal wall thickness:is it associated with superficial and deep incisional surgical site infection after colorectal surgery[J].Surg Infect(Larchmt),2013,14(4):363-8.
[17]钟爱梅,王玉荣.自体脂肪移植与血管形成[J].中国美容医学,2006,15(3):341-3.
[18]Baran CN,Celebio?lu S,Sens?z O,et al.The behavior of fat grafts in recipient areas with enhanced vascularity[J].Plastic Reconstruct Surg,2002,109(5):1646-51.
[19]邹龙,王亮,王晓明,等.心脏外科胸部手术切口愈合不良原因分析及诊治[J].中西医结合心血管病电子杂志,2018,21(19):203-6.
[20]褚月颉,王鹏华.糖尿病伤口愈合不良的相关机制[J].国际内分泌代谢杂志,2014,34(2):131-4.
[21]程志娟,粱葵香.剖宫产腹壁切口两种缝合方法的对比观察[J].中国社区医师,2013,(22):49-51.
[22]冯维国,周尚福.外科手术高频电刀的使用与脂肪液化的关系[J].医学信息,2012,25(1):345-6.
[23]何永棠.普通外科术后切口感染危险因素的分析[J].当代医学,2013,19(3):104-5.
[24]Swenson BR,Hedrick TL,Metzger RA,et al.Effects of preoperative skin preparation on postoperative wound infection rates:a prospective study of 3 skin preparation protocols[J].Infect Control Hospital Epidemiol,2009,30(10):964-71.
[25]张夏英,陈秀榕,罗学琴,等.术前不同时间备皮对切口感染有无差异的临床观察[J].实用护理杂志,2001,17(6):41,56.
[26]陈永红,施学莉,赵敏.麻醉准备室建立术前备皮区对术后切口感染的影响[J].中国医药指南,2013,10(5):402-3.
[27]吴雪琼,陈丽,邬利萍,等.手术室内备皮对预防手术部位感染的影响[J].中华医院感染学杂志,2013,23(16):3896-7,3900.
[28]Chelmow D,Ruehli MS,Huang E.Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes:a meta-analysis[J].Am J Obstet Gynecol,2001,184(4):656-61.
[29]夏在功.腹部切口脂肪液化58例分析[J].中华现代临床医学杂志,2012,18(4):461-5.
[30]周忠信,张思云,陈东,等.腹部愈合不良切口二期缝合的处理体会[J].广东医学,2007,28(10):1626-8.
[31]郭春兰,陈军.感染伤口换药后操作者手污染的监测与手卫生的管理[J].中华医院感染学杂志,2009,19(4):421-2.
[32]蒙荣辉.急性化脓性阑尾炎术后切口感染42例临床分析[J].医学信息,2014,27(29):181-3.
[33]李万荣,陈元飞.高渗葡萄糖粉促进脂肪液化愈合20例[J].中华现代外科学杂志,2006,12(5):580-3.
[2]唐艳琴,邢镝,陈润芳.剖宫产术后腹部切口愈合不良临床调查与分析[J].中华医院感染学杂志,2011,20(19):4028-9.
[3]赵群英.剖宫产术后腹部切口愈合不良32例分析[J].中外医疗,2010,29(31):79-82.
[4]潘秀明.剖宫产切口愈合不良的相关因素探讨及预防[J].中国实用医药,2009,4(13):45-6.
[5]魏凌云,赵一俏,何萍,等.剖宫产手术后切口愈合不良多因素分析[J].中国感染控制杂志,2004,3(2):122-4.
[6]Allami MK,Jamil W,Fourie B,et al.Superficial incisional infection in arthroplasty of the lower limb-Interobserver reliability of the current diagnostic criteria[J].J Bone Joint Surgery-British Volume,2005,87B(9):1267-71.
[7]Cui ZQ,Miao RZ.Diagnosis and treatment of fat liquefaction of abdominal incision[J].J Abdom Surg,2004,14(6):710-6.
[8]Berle P WE,Geburtshilfe UF.Maternal morbidity after abdominal cesarean section in relation to bacterial amniotic fluid colonization and premature rupture of fetal membranes[J].Geburtshilfe Und Frauenheilkunde,1991,51(9):722-6.
[9]叶林阳,林茂虎,郁华亮,等.泌尿系感染与手术切口感染相关性分析[J].中华医院感染学杂志,2007,17(12):1512-4.
[10]Vincent A,Ayzac L,Girard R,et al.Downward trends in surgical site and urinary tract infections after cesarean delivery in a French surveillance network,1997-2003[J].Infect Contr Hospital Epidemiol,2008,29(3):227-33.
[11]俞晶,杨宏英,朱娇阳,等.宫颈癌患者术后感染病原菌及耐药性分析[J].中华医院感染学杂志,2013,23(14):3535-6,3539.
[12]谭辉,伍敬柱,吴林鸿,等.腹腔镜胆囊切除术不同取胆方式切口感染分析[J].中华医院感染学杂志,2015,25(17):4003-5.
[13]刘文丽.普外科切口感染的影响因素及护理对策分析[J].医药卫生:文摘版,2016,18(8):176-8.
[14]赵砚霞,孙广美.洗手护士在手术中预防切口感染的措施[J].中华现代护理学杂志,2005,21(7):712-5.
[15]Tongyoo A,Chatthamrak P,Sriussadaporn E,et al.Risk assessment of abdominal wall thickness measured on Pre-Operative computerized tomography for incisional surgical site infection after abdominal surgery[J].J Med Assoc Thai,2015,98(7):677-83.
[16]Kwaan MR,Sirany AM,Rothenberger DA.Abdominal wall thickness:is it associated with superficial and deep incisional surgical site infection after colorectal surgery[J].Surg Infect(Larchmt),2013,14(4):363-8.
[17]钟爱梅,王玉荣.自体脂肪移植与血管形成[J].中国美容医学,2006,15(3):341-3.
[18]Baran CN,Celebio?lu S,Sens?z O,et al.The behavior of fat grafts in recipient areas with enhanced vascularity[J].Plastic Reconstruct Surg,2002,109(5):1646-51.
[19]邹龙,王亮,王晓明,等.心脏外科胸部手术切口愈合不良原因分析及诊治[J].中西医结合心血管病电子杂志,2018,21(19):203-6.
[20]褚月颉,王鹏华.糖尿病伤口愈合不良的相关机制[J].国际内分泌代谢杂志,2014,34(2):131-4.
[21]程志娟,粱葵香.剖宫产腹壁切口两种缝合方法的对比观察[J].中国社区医师,2013,(22):49-51.
[22]冯维国,周尚福.外科手术高频电刀的使用与脂肪液化的关系[J].医学信息,2012,25(1):345-6.
[23]何永棠.普通外科术后切口感染危险因素的分析[J].当代医学,2013,19(3):104-5.
[24]Swenson BR,Hedrick TL,Metzger RA,et al.Effects of preoperative skin preparation on postoperative wound infection rates:a prospective study of 3 skin preparation protocols[J].Infect Control Hospital Epidemiol,2009,30(10):964-71.
[25]张夏英,陈秀榕,罗学琴,等.术前不同时间备皮对切口感染有无差异的临床观察[J].实用护理杂志,2001,17(6):41,56.
[26]陈永红,施学莉,赵敏.麻醉准备室建立术前备皮区对术后切口感染的影响[J].中国医药指南,2013,10(5):402-3.
[27]吴雪琼,陈丽,邬利萍,等.手术室内备皮对预防手术部位感染的影响[J].中华医院感染学杂志,2013,23(16):3896-7,3900.
[28]Chelmow D,Ruehli MS,Huang E.Prophylactic use of antibiotics for nonlaboring patients undergoing cesarean delivery with intact membranes:a meta-analysis[J].Am J Obstet Gynecol,2001,184(4):656-61.
[29]夏在功.腹部切口脂肪液化58例分析[J].中华现代临床医学杂志,2012,18(4):461-5.
[30]周忠信,张思云,陈东,等.腹部愈合不良切口二期缝合的处理体会[J].广东医学,2007,28(10):1626-8.
[31]郭春兰,陈军.感染伤口换药后操作者手污染的监测与手卫生的管理[J].中华医院感染学杂志,2009,19(4):421-2.
[32]蒙荣辉.急性化脓性阑尾炎术后切口感染42例临床分析[J].医学信息,2014,27(29):181-3.
[33]李万荣,陈元飞.高渗葡萄糖粉促进脂肪液化愈合20例[J].中华现代外科学杂志,2006,12(5):580-3.