Orth Teresa A, Gerkovich Mary M, Heitmann Erica, Overcash Jonnie, Gibbs Charles, Parrish Marc
Division of Maternal Fetal Medicine, Obstetrix Medical Group of Arizona, Tucson, Arizona.
Department of Biomedical and Health Informatics, University of Missouri Kansas City, Kansas City, Missouri.
Surg J (N Y). 2016 Jul 20;2(3):e59-e65. doi: 10.1055/s-0036-1585470. eCollection 2016 Jul.
To determine whether the use of external negative pressure dressing system (ENPDS) can reduce the incidence of wound complications after cesarean delivery (CD) compared with traditional dressings. Retrospective review of all patients undergoing CD between November 2011 and March 2013. Information was collected on demographics, body mass index (BMI), duration of labor, pre- and postnatal infections, incision and dressing type, and postoperative course. Comparisons were made between traditional dressing and an external negative pressure dressing system. Of 970 patients included in the study, wound complications occurred in 50 patients (5.2%). Comparisons of ENPDS ( = 103) and traditional dressing ( = 867) groups revealed higher wound complications for ENPDS with odds ratio (OR) 3.37 and confidence interval (CI) 1.68 to 6.39. ENPDS was more commonly used in patients with BMI > 30 and preexisting diabetes. After controlling for BMI and pregestational diabetes in logistic regression analysis, ENPDS was equivalent to traditional dressing for risk of wound complications with an adjusted OR 2.76 (CI 0.97 to 7.84), with a trend toward more wound complications with ENPDS. Wound separation also tended to be more common in ENPDS group versus traditional dressing with an adjusted OR 2.66 (CI 0.87 to 8.12), although this result did not reach significance. ENPDS is equivalent to traditional dressing for preventing wound complications after controlling for the higher-risk population selected for its use. In particular, wound separation appears to occur more frequently in women treated with ENPDS versus traditional dressing and should be regarded as a potential hazard of the system.
为了确定与传统敷料相比，使用外部负压敷料系统（ENPDS）是否能降低剖宫产术后伤口并发症的发生率。
回顾性分析2011年11月至2013年3月期间所有接受剖宫产的患者。收集了人口统计学、体重指数（BMI）、产程、产前和产后感染、切口和敷料类型以及术后病程等信息。对传统敷料和外部负压敷料系统进行了比较。
在纳入研究的970例患者中，50例（5.2%）发生了伤口并发症。ENPDS组（n = 103）和传统敷料组（n = 867）的比较显示，ENPDS组的伤口并发症更高，优势比（OR）为3.37，置信区间（CI）为1.68至6.39。ENPDS更常用于BMI>30和患有糖尿病的患者。在逻辑回归分析中控制BMI和孕前糖尿病后，ENPDS与传统敷料在伤口并发症风险方面相当，调整后的OR为2.76（CI 0.97至7.84），ENPDS有伤口并发症更多的趋势。与传统敷料相比，ENPDS组伤口裂开也更常见，调整后的OR为2.66（CI 0.87至8.12），尽管这一结果未达到显著水平。
在控制了因使用ENPDS而选择的高风险人群后，ENPDS在预防伤口并发症方面与传统敷料相当。特别是，与传统敷料相比，接受ENPDS治疗的女性伤口裂开似乎更频繁发生，应将其视为该系统的潜在危害。
