随机试验比较三种会阴Ⅱ度裂伤缝合技术。
Randomized Trial of 3 Techniques of Perineal Skin Closure During Second-Degree Perineal Laceration Repair.
机构信息
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
School of Nursing, University of Michigan, Ann Arbor, Michigan.
出版信息
J Midwifery Womens Health. 2019 Sep;64(5):567-577. doi: 10.1111/jmwh.13020. Epub 2019 Aug 21.
INTRODUCTION
Perineal lacerations during childbirth are common, and suturing the perineal skin during repair has been associated with increased postpartum pain. This study sought to test the hypothesis that no difference in postpartum perineal pain exists between 3 methods of skin closure for second-degree repair: suture, no suture, and surgical glue.
METHODS
A single-blind randomized controlled trial of women after vaginal birth who had a second-degree perineal laceration was conducted at a tertiary care teaching hospital from August 2014 to April 2017. Women were randomized to perineal skin closure with suture, no suture, or surgical glue using a 1:1:1 allocation. Pain was assessed using the short-form McGill Pain Questionnaire, a 100-mm visual analog scale (VAS), and Present Pain Index (PPI) at one day, 2 weeks, 6 weeks, and 3 months postpartum. Wound healing was assessed at 6 weeks using the Redness, Edema, Ecchymosis, Drainage, Approximation (REEDA) scale. Pain scores were compared across groups using a chi-square test, Mann-Whitney U test, or analysis of variance where appropriate.
RESULTS
A total of 35 women were randomized: 14 received suture, 11 had no suture, and 10 received surgical glue for perineal skin repair. Demographic characteristics were similar between groups. At 2 weeks postpartum, women with suture had higher median pain scores on the short-form McGill Pain Questionnaire (15.0 suture vs 2.0 glue vs 2.0 no suture, P = .03) and VAS (50.0 suture vs 3.0 glue vs 7.0 no suture, P = .02). Significant differences in pain were not seen on the PPI. At 3 months, women in the suture group had higher median pain scores on the short-form McGill Pain Questionnaire compared with surgical glue (1.0 vs 0, P = .04). Wound healing was similar across groups (REEDA score: 0 suture vs 1.0 no suture, vs 0 surgical glue, P = .24).
DISCUSSION
Compared with no suture and surgical glue, suturing the perineal skin was associated with the highest postpartum pain scores.
简介
分娩时会阴裂伤很常见，在修复过程中缝合会阴皮肤与产后疼痛增加有关。本研究旨在检验以下假设，即对于二度会阴裂伤的三种皮肤缝合方法（缝合、不缝合和手术胶），在产后会阴疼痛方面无差异。
方法
2014 年 8 月至 2017 年 4 月，在一家三级教学医院进行了一项针对阴道分娩后发生二度会阴裂伤的妇女的单盲随机对照试验。使用 1:1:1 分配将女性随机分配至会阴皮肤缝合（缝合、不缝合和手术胶）。在产后 1 天、2 周、6 周和 3 个月时使用简短形式 McGill 疼痛问卷、100mm 视觉模拟量表（VAS）和目前疼痛指数（PPI）评估疼痛。在 6 周时使用红肿、水肿、瘀斑、引流、接近度（REEDA）量表评估伤口愈合情况。使用卡方检验、Mann-Whitney U 检验或适当的方差分析比较组间疼痛评分。
结果
共有 35 名女性被随机分配：14 名接受缝合，11 名不缝合，10 名接受手术胶用于会阴皮肤修复。组间的人口统计学特征相似。在产后 2 周时，接受缝合的女性在简短形式 McGill 疼痛问卷上的中位数疼痛评分更高（15.0 缝合 vs 2.0 胶 vs 2.0 不缝合，P=0.03）和 VAS（50.0 缝合 vs 3.0 胶 vs 7.0 不缝合，P=0.02）。在 PPI 上未观察到明显的疼痛差异。在 3 个月时，缝合组女性在简短形式 McGill 疼痛问卷上的中位数疼痛评分高于手术胶组（1.0 缝合 vs 0 手术胶，P=0.04）。各组之间的伤口愈合情况相似（REEDA 评分：0 缝合 vs 1.0 不缝合，0 手术胶，P=0.24）。
讨论
与不缝合和手术胶相比，缝合会阴皮肤与产后疼痛评分最高相关。
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