Tang Hao, Liu Dong, Qi Hai-Feng, Liang Ze-Ping, Zhang Xiu-Zhu, Jiang Dong-Po, Zhang Lian-Yang
Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
Trauma Center, State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
Chin J Traumatol. 2018 Feb;21(1):20-26. doi: 10.1016/j.cjtee.2017.08.008. Epub 2018 Jan 31.
To evaluate the effect of retention sutures on abdominal pressure and postoperative prognosis in abdominal surgery patients.
This prospective cohort study included patients who were admitted to Daping Hospital from May 15, 2014 to October 11, 2014. A total of 57 patients were enrolled, including 18 patients in the "U" type retention suture group, 17 patients in the intermittent retention suture group, and 22 patients in non-retention suture group. The demographic data, clinical data and risk factors for abdominal wound dehiscence were recorded. The bladder pressure (IVP) was monitored preoperatively, intraoperatively, and four days postoperatively. Additionally, the incidence of abdominal wound dehiscence and infection 14 days after the operation was recorded.
During the operation, the IVP decreased and then increased; it was at its lowest 1 h after the start of the operation (5.3 mmHg ± 3.2 mmHg) and peaked after tension-reducing (8.8 mmHg ± 4.0 mmHg). The IVP values in the "U" type retention suture group and intermittent retention suture group were higher than in the non-retention suture group 4 days after operation (p < 0.005). The Visual Analogue Scale (VAS) pain scores were 3.9 ± 2.2, 3.8 ± 2.0, and 3.0 ± 1.0 in the retention suture group, intermittent retention suture group and non-retention suture group, respectively. The VAS pain scores in the "U" type tension-reducing group and intermittent tension-reducing group were higher than in the non-tension-reducing group (p < 0.005).
Although retention sutures may reduce the incidence of postoperative wound dehiscence in abdominal surgery patients, they can increase the IVP and postoperative pain.
评估腹部手术患者中保留缝线对腹内压及术后预后的影响。
这项前瞻性队列研究纳入了2014年5月15日至2014年10月11日入住大坪医院的患者。共纳入57例患者,其中“U”型保留缝线组18例,间断保留缝线组17例,非保留缝线组22例。记录人口统计学数据、临床数据及腹部伤口裂开的危险因素。术前、术中及术后4天监测膀胱压力(IVP)。此外,记录术后14天腹部伤口裂开及感染的发生率。
手术过程中,IVP先降低后升高;在手术开始后1小时最低(5.3 mmHg ± 3.2 mmHg),在减张后达到峰值(8.8 mmHg ± 4.0 mmHg)。术后4天,“U”型保留缝线组和间断保留缝线组的IVP值高于非保留缝线组(p < 0.005)。保留缝线组、间断保留缝线组和非保留缝线组的视觉模拟评分(VAS)疼痛评分分别为3.9 ± 2.2、3.8 ± 2.0和3.0 ± 1.0。“U”型减张组和间断减张组的VAS疼痛评分高于非减张组(p < 0.005)。
虽然保留缝线可能降低腹部手术患者术后伤口裂开的发生率,但会增加IVP及术后疼痛。