阴道分娩会阴侧切伤口愈合的影响因素及护理对策
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摘要
目的探究影响阴道分娩中会阴侧切口愈合的影响因素及相应的护理对策。方法选取2016年7月—2018年2月在我院接受治疗的385例阴道分娩行会阴侧切的产妇作为研究对象,100%行阴道侧切术,其中351例(91.17%)术后正常愈合,34例(8.83%)愈合不良。34例愈合不良患者中,19例切口感染(55.88%)、9例脂肪液化(26.47%),6例切口裂开(17.65%)。探讨术后正常愈合与愈合不良之间的临床资料差异,并使用Logistic回归方程对切口愈合不良因素进行分析。结果正常愈合组合并基础疾病、缝合操作不佳、产褥期护理不当比例、产程中阴道检查次数均低于愈合不良组;术前抗生素预防、侧切术角度(改良法)比例高于愈合不良组,差异均具有统计学意义(P <0.05)。Logistic分析显示:合并基础疾病,术前抗生素预防、侧切术角度(改良法)、产程中阴道检查次数、缝合操作不佳、产褥期护理不当均为影响会阴侧切伤口愈合影响因素(P<0.05)。结论应结合影响会阴侧切伤口愈合的影响因素针对性展开综合护理措施,促进会阴切口Ⅰ期愈合,提高切口愈合率与产妇生活质量。
Objective To explore the adverse factors affecting the healing of perineal incision in vaginal delivery and the corresponding nursing countermeasures. Methods From July 2016 to February 2018, 385 parturients who underwent lateral episiotomy for vaginal delivery in our hospital were selected as subjects. 100% of them underwent lateral vaginal resection. Of them, 351(91.17%) had normal healing and 34(8.83%) had poor healing. Among 34 patients with poor healing, 19 cases had incision infection(55.88%), 9 cases had fat liquefaction(26.47%) and 6 cases hadincision dehiscence(17.65%). The difference of clinical data between normal healing and poor healing after operation was investigated, and the factors of poor healing of incision with logistic regression equation was analyzed. Results The proportion of normal healing group with underlying diseases, poor suture operation, improper puerperal care, vaginal examination times in the course of labor were lower than those in the poor healing group; the proportion of antibiotic prevention and lateral incision angle(improved method) before operation was higher than that in the poor healing group, and the difference was statistically significant(P < 0.05). Logistic analysis showed that the risk factors of poor perineal incision healing were associated with underlying diseases, antibiotic prophylaxis, lateral incision angle(improved method), vaginal examination times during labor, poor suture operation and improper puerperal care(P < 0.05). Conclusion Comprehensive nursing measures should be carried out according to the factors influencing the wound healing of lateral episiotomy so as to promote the primary healing of perineal incision and improve the wound healing rate and the quality of maternal life.
Objective To explore the adverse factors affecting the healing of perineal incision in vaginal delivery and the corresponding nursing countermeasures. Methods From July 2016 to February 2018, 385 parturients who underwent lateral episiotomy for vaginal delivery in our hospital were selected as subjects. 100% of them underwent lateral vaginal resection. Of them, 351(91.17%) had normal healing and 34(8.83%) had poor healing. Among 34 patients with poor healing, 19 cases had incision infection(55.88%), 9 cases had fat liquefaction(26.47%) and 6 cases hadincision dehiscence(17.65%). The difference of clinical data between normal healing and poor healing after operation was investigated, and the factors of poor healing of incision with logistic regression equation was analyzed. Results The proportion of normal healing group with underlying diseases, poor suture operation, improper puerperal care, vaginal examination times in the course of labor were lower than those in the poor healing group; the proportion of antibiotic prevention and lateral incision angle(improved method) before operation was higher than that in the poor healing group, and the difference was statistically significant(P < 0.05). Logistic analysis showed that the risk factors of poor perineal incision healing were associated with underlying diseases, antibiotic prophylaxis, lateral incision angle(improved method), vaginal examination times during labor, poor suture operation and improper puerperal care(P < 0.05). Conclusion Comprehensive nursing measures should be carried out according to the factors influencing the wound healing of lateral episiotomy so as to promote the primary healing of perineal incision and improve the wound healing rate and the quality of maternal life.
引文
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[2]唐洁.影响会阴侧切伤口的感染因素及预防措施[J].上海护理,2017,17(7):126-128.
[3]卢彩良.产妇产后会阴伤口愈合不良原因分析及护理研究[J].中国实用医药,2016,11(16):244-245.
[4]卢春红.探讨阴道分娩会阴侧切伤口裂开的原因及预防措施[J].世界最新医学信息文摘,2017(43):105,107.
[5]王淑端,赵俊芳.阴道分娩后会阴伤口疼痛原因分析及护理[J].中外女性健康研究,2017(5):55-56.
[6]陈思,叶宇齐,王静,等.经阴道分娩结局与会阴侧切的临床分析[J].中国计划生育和妇产科,2016,8(3):17-19.
[7]刘静.分娩中会阴侧切术的护理体会[J].河南外科学杂志,2017,23(1):159-160.
[8]翟芬.经产妇阴道分娩时会阴侧切和会阴自然裂伤对盆底功能的影响研究[J].实用临床护理学电子杂志,2017,2(11):114,117.
[9]岳风枝.阴道分娩产后出血的相关高危因素分析及护理干预措施[J].河南预防医学杂志,2017,28(7):495-497.
[10]潘红霞.会阴侧切术的护理体会[J].中国保健营养,2016,26(20):126-128.
[11]邢艳梅,孙彦华,吕艳丽,等.孕妇产后会阴侧切伤口愈合不良原因分析[J].北京医学,2018,9(2):126-128.
[12]刘艳.阴道分娩会阴侧切术后伴阴道深部延裂的原因与改良缝合的临床分析[J].临床医药文献电子杂志,2017,4(6):1030.
[13]凌晨丽.改良式小角度会阴侧切术的临床观察[J].淮海医药,2013,31(1):59-60.