术中因素对产后脓毒症并发症发生的影响。
Impact of Intraoperative Factors on the Development of Postpartum Septic Complications.
机构信息
Riga Maternity Hospital, Miera Street 45, LV-1013 Riga, Latvia.
Gynaecology Clinic, Riga East Clinical University Hospital, Hipokrata Street 2, LV-1079 Riga, Latvia.
出版信息
Medicina (Kaunas). 2023 Sep 10;59(9):1637. doi: 10.3390/medicina59091637.
Triclosan-coated sutures (antibacterial sutures) can reduce the risk of postoperative surgical site infection. This study aimed to investigate the effect of intraoperative factors, including antibacterial sutures, on the risk of postpartum septic complications. The prospective study included patients who underwent caesarean section. The exclusion criterion was chorioamnionitis. The investigation group patient's ( = 67) uterus and fascial sheath of the abdominal wall were sutured with triclosan-coated polyglactin 910 sutures during surgery. The control group consisted of 98 patients using uncoated polyglactin 910 sutures only. The patients were contacted by phone after the 30th postoperative day. No significant difference was found between the investigation group and the control group in the development of postpartum endometritis (11.7% in the investigation group vs. 8.4% in the control group, = 0.401), wound infection (6.3% vs. 3.6%, = 0.444) or patients experienced any septic complication (15.9% vs. 12%, = 0.506). Postpartum endometritis was more common in patients who underwent instrumental uterine examination during the surgery (23.8% vs. 18%, = 0.043). A moderately strong correlation was found for haemoglobin level on the third-fourth postoperative day with the development of postpartum septic complications, < 0.001, Pearson coefficient -0.319. Post-caesarean delivery septic complications were not statistically more common in patients with blood loss greater than 1 L. The incidence of post-caesarean endometritis was 13.4%, and wound infection was 4.8% in this study's hospital, having five to six thousand deliveries per year. Using antibacterial sutures during caesarean section does not affect the incidence of postpartum septic complications. Instrumental uterine examination during caesarean section increases the risk of post-caesarean endometritis and is, therefore, not recommended. Haemoglobin level on the 3rd-4th postoperative day, rather than the estimated blood loss during surgery, affects the development of postpartum septic complications.
三氯生涂层缝线（抗菌缝线）可降低术后手术部位感染的风险。本研究旨在探讨术中因素（包括抗菌缝线）对产后脓毒症并发症风险的影响。这项前瞻性研究纳入了行剖宫产术的患者。排除标准为绒毛膜羊膜炎。观察组（n=67）患者的子宫和腹壁筋膜在术中使用三氯生涂层聚乳酸 910 缝线缝合，对照组（n=98）患者仅使用未涂层的聚乳酸 910 缝线。术后第 30 天通过电话联系患者。观察组和对照组在后发生子宫内膜炎（观察组 11.7% vs. 对照组 8.4%， = 0.401）、伤口感染（观察组 6.3% vs. 对照组 3.6%， = 0.444）或任何脓毒症并发症（观察组 15.9% vs. 对照组 12%， = 0.506）的患者数量上没有显著差异。术中进行器械性子宫检查的患者发生产后子宫内膜炎的比例更高（观察组 23.8% vs. 对照组 18%， = 0.043）。术后第 3-4 天血红蛋白水平与产后脓毒症并发症的发展之间存在中度强相关性， < 0.001，Pearson 系数-0.319。术中出血量大于 1 L 的患者术后发生剖宫产术后脓毒症并发症的比例无统计学差异。本研究所在医院的剖宫产术后子宫内膜炎发生率为 13.4%，伤口感染发生率为 4.8%，每年有 5000-6000 例分娩。剖宫产术中使用抗菌缝线不会增加产后脓毒症并发症的发生率。剖宫产术中进行器械性子宫检查会增加产后子宫内膜炎的风险，因此不推荐使用。术后第 3-4 天的血红蛋白水平，而不是手术中的估计出血量，会影响产后脓毒症并发症的发展。
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