Risk Factors For Poor Abdominal Incision Healing After Cesarean Section And The Role Of VSD In Its Treatment

Objective:To investigate the independent risk factors of poor abdominal incision healing(PAIH)after cesarean section.The vacuum sealing drainage(VSD)technology was evaluated for its clinical efficacy and its promotion mechanism promoting wound healing in PAIH patients was explored preliminary.Methods:1.Retrospective analysis was performed on 7630 cases of women who delivered by cesarean section in the obstetrics department of Fujian Provincial Hospital from January 2014 to September 2020,and the incidence of PAIH was counted.We selected the control group randomly using retrospective nested case-control study.We compared the clinical data of the PAIH group(people with poor abdominal wound healing)and the control group(people who underwent cesarean section at the same time,class-a abdominal wound healing).Logistic multivariate regression method was used to analyze the independent risk factors of PAIH after cesarean section.2.Total of 62 PAIH postpartum women after cesarean section in the obstetrics department of Fujian Provincial Hospital were randomly divided into the conventional group and the VSD group from September 2017 to September 2020.20 cases in the VSD group were treated by vacuum sealing drainage(VSD)technology and 42 cases were treated in the control group by conventional debridement dressing.The clinical efficacy of VSD was evaluated by comparing the length of hospitalization,hospitalization expense,number of dressing changes and the number of visual analogue scale(VAS)on the 3rd,7th and 11 th day after cesarean section.The mechanism of VSD promoting wound healing in PAIH patients was interpretation preliminary by comparing the levels of serum vascular endothelial growth factor(VEGF),platelet derived growth factor(PDGF),interleukin(IL)-1β and hypersensitive C-reative protein(hs-CRP)were compared on the 3rd,7th and 11 th day after cesarean section.Results:1.There were 7630 cases of cesarean delivery,among which 98 cases developed PAIH.The incidence of PAIH after cesarean section in our hospital was 1.28%.It was most often found 5 days(2～6 days)after cesarean section.The hospitalization days in the PAIH group were significantly longer than that in the control group,with statistical difference(t=21.629,P<0.001).The result of logistic multivariate regression analysis showed that cesarean scar uterus trial delivery(OR=3.765,P=0.029),hyperglycated hemoglobin(OR=2.041,P=0.033)and moderate to severe anemia during pregnancy(OR=2.224,P=0.033)were independent risk factors for PAIH after cesarean section.2.The hospitalization days in the VSD group were 12.10±2.40 days which was less than that in the control group 15.38±3.89 days,with statistical difference(t=3.468,P=0.001).The hospitalization expenses in the VSD group were 18399.44±4421.67 yuan,which was more expensive than that in the control group 13846.27±4348.31 yuan,with statistical difference(t=3.834,P<0.001).The number of dressing changes in the VSD group were 5.70±1.34,which was less than that in the control group 12.81±4.01,with statistical difference(t=10.331,P<0.001).The scores of VAS in the VSD group and the VSD group were 5.50±1.10 and 5.88±1.04 respectively on the 3rd day,with no statistical difference(P=0.191).The scores of VAS in the VSD group on the 7th day were(2.70±0.87,which was less than in the control group 4.50±0.94,with statistical difference(t=7.028,P<0.001).The scores of VAS in the VSD group on the 11 th day were 1.45±0.51,which was less than in the control group 2.98±0.64,with statistical difference(t=9.293,P<0.001).There were no significant differences in the levels of serum VEGF,PDGF,IL-1β and hs-CRP between the VSD group and the control group on the 3rd day after cesarean section(P>0.05).The levels of serum VEGF on the 7th day in VSD group were 119.09±18.97 ng/L,which was significantly more than those in the conventional group 108.87±15.40 ng/L(P=0.027).The levels of serum VEGF on the 11 th day in VSD group were 144.68±15.07 ng/L,which was significantly more than those in the conventional group 126.33±14.89 ng/L(P<0.001).The levels of serum PDGF on the 7th day in VSD group were 51.49±4.67 ng/L,which was significantly more than those in the conventional group 47.74±5.30 ng/L(P=0.009).The levels of serum PDGF on the 11 th day in VSD group were 60.88±6.56 ng/L,which was significantly more than those in the conventional group 53.87±6.78 ng/L(P<0.001).The levels of serum IL-1β on the 7th day in VSD group were 1.86±0.54 ng/L,which was significantly less than those in the conventional group 2.82±1.19 ng/L(P<0.001).The levels of serum IL-1β on the 11 th day in VSD group were 0.74±0.57 ng/L,which was significantly less than those in the conventional group 1.56±0.87 ng/L(P<0.001).The levels of serum hs-CRP on the 7th day in VSD group were 4.29±0.97 mg/L,which was significantly less than those in the conventional group 5.73±1.56 mg/L(P<0.001).The levels of serum hs-CRP on the 11 th day in VSD group were 1.68±1.02 mg/L,which was significantly less than those in the conventional group 3.66±2.21 mg/L(P<0.001).Conclusions:1.Cesarean scar uterus trial delivery,hyperglycated hemoglobin and moderate to severe anemia during pregnancy were independent risk factors for PAIH after cesarean section.2.VSD promote wound healing in PAIH patients,which might be involved in increasing the VEGF and PDGF levels and reducing the IL-1β and hs-CRP levels in serum.3.VSD is effective in the treatment of PAIH after cesarean section,which is especially suitable for maternal with cesarean scar uterus trial delivery,hyperglycated hemoglobin and moderate to severe anemia during pregnancy after cesarean section.