关键词: 结核, 淋巴结, 手术后医护, 伤口愈合, 危险因素, 因素分析, 统计学

Abstract:

Objective To analyze the risk factors affecting wound healing time after natural ulceration of cervical lymph node tuberculosis and lymph node incision.Methods A totol of 189 patients with cervical lymph node tuberculosis admitted to the Department of Tuberculosis, Shanghai Pulmonary Hospital Affiliated to Tongji University were selected. Diagnosed as cervical lymph node tuberculosis by wound secretion culture and clinical comprehensive diagnosis, they met the inclusion criteria and underwent dressing changes after natural ulceration of cervical lymph node tuberculosis and lymph node incision in the outpatient department. The wound healing time of 189 patients was 62-166 days, with an average of (90.3±12.1) days. With the average wound healing time 90 days as the threshold value, 47 cases (24.9%) had a wound healing time ≥90 d (≥90d group) and 142 cases (75.1%) <90 d (<90d group). Univariate and multivariate logistic regressions were used to analyze the effect of age, gender, education, income, history of smoking, history of alcohol consumption, body mass index (BMI), maximum diameter of lesions, extent of lymph node involvement, whether complicated by diabetes, whether complicated by tuberculosis, whether regular of dressing changes, and other 12 related factors on the healing time of cervical lymph node tuberculosis wounds. Data were analyzed by χ ² test using SPSS 17.0, P<0.05 was considered statistically significant. Results Univariate analysis showed that there were statistically significant differences of BMI <18.4 (58.5% (83/142) vs. 85.1% (40/47); χ ²=11.040, P=0.001), number of involved lymph nodes ≥2 (22.5% (32/142) vs. 38.3% (18/47); χ ²=4.509, P=0.034), maximum diameter of lesions ≥ 2.0 cm (61.3% (87/142) vs. 80.9% (38/47); χ ²=6.047, P=0.014), complicated by diabetes (36.6% (52/142) vs. 57.4% (27/47); χ ²=6.296, P=0.012), irregular dressing changes (13.4% (19/142) vs. 72.3% (34/47);χ ²=61.835, P=0.000), etc. in the two groups of patients with wounding healing time <90 d and ≥90 d. Multivariate logistic regression analysis showed that the risk factors affecting wound healing of tuberculosis in cervical lymph nodes included BMI <18.4 (Wald χ ²=3.553, P=0.019, OR (95%CI):4.062 (0.117-7.981)), number of involved lymph nodes≥2 (Wald χ ²=4.223, P=0.040, OR (95%CI):2.134 (1.172-19.119)), maximum diameter of lesions ≥ 2.0 cm (Wald χ ²=8.573, P=0.003, OR (95%CI):2.669 (1.169-10.815)), complicated by diabetes (Wald χ ²=5.021, P=0.025, OR (95%CI):2.337 (1.776-4.442)), and irregular dressing changes (Wald χ ²=26.346, P=0.000, OR (95%CI):16.900 (14.061-32.786)). Conclusion Special attention should be paid to patients with BMI <18.4, number of involved lymph nodes ≥2, complicated by diabetes, maximum diameter of lesions ≥2.0 cm and irregular dressing changes to avoid prolonged lymph node tuberculosis wounds.

Key words: Tuberculosis, lymph nodes, Post-operative care, Wound healing, Risk factors, Factor analysis, statistics