Sullivan Scott, Williamson Bridget, Wilson Lisa K, Korte Jeffrey E, Soper David
From the Departments of Obstetrics and Gynecology and Biostatistics, Bioinformatics and Epidemiology, Medical University of South Carolina, Charleston, South Carolina.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):211-216. doi: 10.1097/AOG.0b013e3181ae9b4a.
To compare the rate of glove perforation as a proxy for needlestick injuries between blunt and sharp needles used during cesarean-delivery closure and to survey physician satisfaction with blunt needles.
Patients requiring cesarean delivery were assigned randomly to receive closure with either blunt (study group) or sharp needles (control group). Patient demographics, operator experience, and other clinical variables were collected. Physicians reported any percutaneous injuries and were surveyed regarding satisfaction with the assigned needles. Glove perforation was determined using a validated water-test method. Differences between patient groups were tested using chi and Fisher exact test for categorical variables and Student t-test or Wilcoxon rank-sum test for continuous variables.
There were 194 patients enrolled in the trial: 97 in the control group and 97 in the study group. There were no statistical differences between groups in patient demographics. There were no differences between groups in clinical variables, type of cesarean delivery, or experience level of the surgeon. There was a significant reduction in total glove perforation rate for the primary surgeon with blunt needles (7.2%) compared with sharp needles (17.5%) (relative risk [RR] 0.66, 95% confidence interval [CI] 0.49-0.89) as well as for the assistant surgeon (RR 0.54, 95% CI 0.41-0.71). There was poor correlation between reported perforations and those detected by water test (R=0.3). Physicians reported that they were not as satisfied with blunt needles compared with sharp needles (P=.001).
There was a significant decrease in the rate of glove perforation for surgeons and assistants performing cesarean-delivery closure with blunt needles. Assistant surgeons had the greatest reduction in glove perforations. However, physicians reported decreased satisfaction performing the surgery with blunt needles.
ClinicalTrials.gov, www.clinicaltrials.gov, NCT00844636
I.
比较剖宫产缝合时钝针与锐针导致手套穿孔（作为针刺伤替代指标）的发生率，并调查医生对钝针的满意度。
将需要剖宫产的患者随机分配，分别使用钝针（研究组）或锐针（对照组）进行缝合。收集患者人口统计学资料、术者经验及其他临床变量。医生报告任何经皮损伤情况，并就对所分配使用的针具的满意度接受调查。采用经过验证的水测试方法确定手套穿孔情况。对于分类变量，使用卡方检验和Fisher精确检验比较患者组间差异；对于连续变量，使用Student t检验或Wilcoxon秩和检验。
194例患者纳入试验：对照组97例，研究组97例。两组患者在人口统计学方面无统计学差异。临床变量、剖宫产类型或外科医生经验水平在两组间均无差异。与锐针（17.5%）相比，主刀医生使用钝针时总的手套穿孔率显著降低（7.2%）（相对危险度[RR] 0.66，95%置信区间[CI] 0.49 - 0.89），助手医生也是如此（RR 0.54，95% CI 0.41 - 0. VII）。报告的穿孔情况与水测试检测到的穿孔情况之间相关性较差（R = 0.3）。医生报告称，与锐针相比，他们对钝针的满意度较低（P = 0.001）。
对于进行剖宫产缝合的外科医生和助手而言，使用钝针可使手套穿孔率显著降低。助手医生的手套穿孔减少幅度最大。然而，医生报告称使用钝针进行手术时满意度降低。
ClinicalTrials.gov，www.clinicaltrials.gov，NCT00844636
I级
