FACTORS INFLUENCING WOUND DEHISCENCE
FACTORS INFLUENCING WOUND DEHISCENCE
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DOI：
10.1016/0002-9610(92)90014-i
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发表时间：
1992-03-01
影响因子：
3
通讯作者：
JOHNSON, H
中科院分区：
文献类型：
--
作者：
RIOU, JPA;COHEN, JR;JOHNSON, H
在5年期间，2，761例接受腹部大手术的患者中发生了31例腹部筋膜伤口裂开（1%）。分析了22个特定的局部和全身风险因素，并与对照组38例接受类似手术而无裂开的患者的风险因素进行了比较。通过多变量分析，每个因素作为一个独立的统计变量进行评估。发现显著性因素（p < 0.05）包括年龄超过65岁、伤口感染、肺部疾病、血流动力学不稳定和切口造口术。其他显著的全身性风险因素包括低蛋白血症、全身性感染、肥胖、尿毒症、高营养、恶性肿瘤、腹水、类固醇使用和高血压。未发现为重要独立变量的风险因素包括性别、切口类型、闭合类型、伤口异物、贫血、黄疸和糖尿病。当将裂开组和对照组合并时，30%具有至少5个显著风险因素的患者发生裂开，所有具有8个以上风险因素的患者均发生伤口裂开。总死亡率为29%，这与显著风险因素的数量直接相关。9种危险因素并存者死亡率为1/3，危险因素超过10种者全部死亡。
Thirty-one abdominal fascial wound dehiscences occurred in 2,761 patients undergoing major abdominal surgery during a 5-year period (1%). Twenty-two specific local and systemic risk factors were analyzed and compared with the risk factors of a control group of 38 patients undergoing similar procedures without dehiscence. Through multivariate analysis, each factor was assessed as an independent statistical variable. Significant factors (p < 0.05) were found to include age over 65, wound infection, pulmonary disease, hemodynamic instability, and ostomies in the incision. Additional systemic risk factors that were found to be significant included hypoproteinemia, systemic infection, obesity, uremia, hyperalimentation, malignancy, ascites, steroid use, and hypertension. Risk factors not found to be important independent variables included sex, type of incision, type of closure, foreign body in the wound, anemia, jaundice, and diabetes. When dehiscence and control groups were combined, 30% of patients with at least five significant risk factors developed dehiscence, and all the patients with more than eight risk factors developed a wound dehiscence. There was an overall mortality of 29%, which was directly related to the number of significant risk factors. The co-existence of 9 risk factors portended death in one third of the patients, and all the patients with more than 10 risk factors died.