接受初次剖宫产的极度肥胖女性伤口并发症的危险因素。
Risk factors for wound complications in morbidly obese women undergoing primary cesarean delivery.
作者信息
Thornburg Loralei L, Linder Mitchell A, Durie Danielle E, Walker Brittany, Pressman Eva K, Glantz J Christopher
机构信息
Department of Obstetrics & Gynecology, University of Rochester Medical Center, Rochester, NY 14642, USA.
出版信息
J Matern Fetal Neonatal Med. 2012 Sep;25(9):1544-8. doi: 10.3109/14767058.2011.653422. Epub 2012 Feb 13.
OBJECTIVE
To determine factors influencing separation and infectious type wound complications (WCs) in morbidly obese women undergoing primary cesarean delivery (CD).
METHODS
Retrospective cohort study evaluating infectious and separation WC in morbidly obese (body mass index [BMI] > 35 kg/m(2)) women undergoing primary CD between January 1994 and December 2008. Chi-square, Fisher's exact and Student's t tests used to assess associated factors; backward logistic regression to determine unadjusted and adjusted odds ratios.
RESULTS
Of 623 women, low transverse skin incisions were performed in 588 (94.4%), vertical in 35 (7%). Overall WC rate was 13.5%, which varied by incision type (vertical 45.7% vs. 11.6% transverse; p < 0.01), but not BMI class. Incision type and unscheduled CD were associated with infection risk, while incision type, BMI, race and drain use were associated with wound separation.
CONCLUSION
In morbidly obese women both infectious and separation type WC are more common in vertical than low transverse incisions; therefore transverse should be preferred.
目的
确定影响接受初次剖宫产（CD）的病态肥胖女性伤口分离及感染性伤口并发症（WC）的因素。
方法
回顾性队列研究，评估1994年1月至2008年12月期间接受初次CD的病态肥胖（体重指数[BMI]>35 kg/m²）女性的感染性和伤口分离WC情况。采用卡方检验、Fisher精确检验和学生t检验评估相关因素；采用向后逻辑回归确定未调整和调整后的比值比。
结果
623名女性中，588例（94.4%）采用低位横切口，35例（7%）采用纵切口。总体WC发生率为13.5%，因切口类型而异（纵切口为45.7%，横切口为11.6%；p<0.01），但与BMI类别无关。切口类型和非计划性CD与感染风险相关，而切口类型、BMI、种族和引流管使用与伤口分离相关。
结论
在病态肥胖女性中，感染性和伤口分离型WC在纵切口中比低位横切口中更常见；因此应首选横切口。
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