阴道分娩后会阴伤口愈合不良的危险因素分析及预测模型构建：一项回顾性病例对照研究
Analysis of risk factors and prediction model construction for poor healing of perineal wounds after vaginal delivery: A retrospective case-control study.
作者信息
Cai Chunyu, Shan Shanshan, Chen Xiaoyan, Yao Xiao, Liu Ying, Jiang Hui
机构信息
Delivery Room, Shanghai First Maternity and Infant Hospital, Obstetrics and Gynecology Hospital Affiliated to Tongji University, Shanghai, PR China.
Nursing Department, Shanghai First Maternity and Infant Hospital, Obstetrics and Gynecology Hospital Affiliated to Tongji University, Shanghai, PR China.
出版信息
Int J Nurs Stud Adv. 2025 Apr 8;8:100326. doi: 10.1016/j.ijnsa.2025.100326. eCollection 2025 Jun.
BACKGROUND
Perineal wounds after vaginal delivery are very common, but the existing evidence for poor healing of perineal wounds is limited. Although some studies have analyzed the risk factors for poor perineal wound healing, there are currently no simple and practical predictive tools available for clinical use.
OBJECTIVE
To retrospectively analyze the independent risk factors for poor perineal wound healing after vaginal delivery and to establish a risk prediction model for poor perineal wound healing.
DESIGN
A Retrospective Case-Control Study.
DATA SOURCE
A total of 167 cases of poor perineal wound healing after vaginal delivery who visited the emergency department from May 2021 to September 2023 in our hospital were selected as the poor perineal wound healing group. The control group was randomly selected by the random number table method at a ratio of 1:2 from those with normal perineal wound healing during the same period.
METHODS
Clinical indicators of the two groups were analyzed, and the risk factors for poor perineal wound healing were analyzed using univariate and multivariate Logistic regression analysis, and a risk prediction model was constructed. A nomogram was drawn, and the model was evaluated by discrimination and calibration.
RESULTS
This study ultimately included four independent risk factors to construct the risk prediction model, including primiparity, perineal laceration, perineal laceration combined with laceration, and vaginal hematoma. The model formula was = 2.256 + 2.7 × (episiotomy with laceration) + 1.5 × (episiotomy) + 1.321 × (vaginal hematoma) + 0.904 × (primiparity). The area under the ROC curve of the constructed model was 0.757 (95 % CI: 0.712-0.803), and the optimal cutoff value was 0.194, at which the model sensitivity was 0.952 and specificity was 0.759.
CONCLUSIONS
The risk prediction model for poor perineal wound healing after vaginal delivery can reasonably predict the risk of poor incision healing, providing a basis for obstetric medical staff to take preventive management measures for high-risk groups before the discharge of parturient women, thereby reducing the occurrence of poor perineal wound healing.
背景
阴道分娩后会阴伤口非常常见，但现有会阴伤口愈合不良的证据有限。尽管一些研究分析了会阴伤口愈合不良的危险因素，但目前尚无简单实用的预测工具可供临床使用。
目的
回顾性分析阴道分娩后会阴伤口愈合不良的独立危险因素，并建立会阴伤口愈合不良的风险预测模型。
设计
一项回顾性病例对照研究。
数据来源
选取2021年5月至2023年9月在我院急诊科就诊的167例阴道分娩后会阴伤口愈合不良的患者作为会阴伤口愈合不良组。对照组采用随机数字表法按1:2的比例从同期会阴伤口愈合正常的患者中随机选取。
方法
分析两组的临床指标，采用单因素和多因素Logistic回归分析会阴伤口愈合不良的危险因素，并构建风险预测模型。绘制列线图，并通过区分度和校准对模型进行评估。
结果
本研究最终纳入4个独立危险因素构建风险预测模型，包括初产妇、会阴裂伤、会阴裂伤合并侧切、阴道血肿。模型公式为=2.256 + 2.7×（侧切伴裂伤）+ 1.5×（侧切）+ 1.321×（阴道血肿）+ 0.904×（初产妇）。构建模型的ROC曲线下面积为0.757（95%CI：0.712 - 0.803），最佳截断值为0.194，此时模型灵敏度为0.952，特异度为0.759。
结论
阴道分娩后会阴伤口愈合不良的风险预测模型能够合理预测切口愈合不良的风险，为产科医护人员在产妇出院前对高危人群采取预防性管理措施提供依据，从而减少会阴伤口愈合不良的发生。
Zotero 插件