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中国防痨杂志 ›› 2019, Vol. 41 ›› Issue (8): 857-862.doi: 10.3969/j.issn.1000-6621.2019.08.010

• 论著 • 上一篇    下一篇

颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的影响因素分析

高颖,王琳(),陈丽娜   

  1. 上海市第二康复医院护理部(王琳)
  • 收稿日期:2019-03-07 出版日期:2019-08-10 发布日期:2019-08-13
  • 通信作者: 王琳 E-mail:1115262827@qq.com
  • 基金资助:
    上海市肺科医院护理科研项目(HL201707)

Analysis of factors affecting wound healing time after natural ulceration of cervical lymph node tuberculosis and lymph node incision

Ying GAO,Lin WANG(),Li-na CHEN   

  1. *Department 2th of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine,Shanghai 200433,China
  • Received:2019-03-07 Online:2019-08-10 Published:2019-08-13
  • Contact: Lin WANG E-mail:1115262827@qq.com

摘要:

目的 分析影响颈部淋巴结结核自然破溃和淋巴结切开术后伤口愈合时间的危险因素。方法 收集2014年1月至2018年7月同济大学附属上海市肺科医院结核科经伤口分泌物培养及临床综合诊断确诊为颈部淋巴结结核且符合入选标准,并于结核科门诊因自然破溃和淋巴结切开术后行伤口换药的189例患者。189例患者伤口愈合时间为62~166d,平均(90.3±12.1)d。以伤口愈合平均时间90d作为界限值,47例(24.9%)伤口愈合时间≥90d (≥90d组),142例(75.1%)<90d (<90d组)。采用SPSS 17.0软件将两组患者的年龄、性别、文化程度、经济收入、有无吸烟史、有无饮酒史、体质量指数(BMI)、病灶最大直径、受累淋巴结数量、是否并发糖尿病、是否并发肺结核、是否规律换药等12项相关因素进行对颈部淋巴结结核伤口愈合时间影响的单因素及多因素logistic回归分析,计数资料间的比较采用χ2检验,以P<0.05为差异有统计学意义。结果 单因素分析结果显示,<90d组和≥90d组患者在BMI<18.4[58.5%(83/142)和85.1%(40/47)]、受累淋巴结≥2枚[22.5%(32/142)和38.3%(18/47)]、病灶最大直径≥2.0cm[61.3%(87/142)和80.9%(38/47)]、并发糖尿病[36.6%(52/142)和57.4%(27/47)]、不规律换药[13.4% (19/142) 和72.3% (34/47))]等方面差异均有统计学意义(χ2值分别为11.040、4.509、6.047、6.296、61.835,P值分别为0.001、0.034、0.014、0.012、0.000)。多因素logistic回归分析结果显示,BMI<18.4[Wald χ2=3.553,P=0.019,OR(95%CI)=4.062(0.117~7.981)]、受累淋巴结≥2枚[Wald χ2=4.223,P=0.040,OR(95%CI)=2.134(1.172~19.119)]、病灶最大直径≥2.0cm[Wald χ2=8.573,P=0.003,OR(95%CI)=2.669(1.169~10.815)]、并发糖尿病[Wald χ2=5.021,P=0.025,OR(95%CI)=2.337(1.776~4.442)]、不规律换药[Wald χ2=26.346,P=0.000,OR(95%CI)=16.900(14.061~32.786)]是影响颈部淋巴结结核伤口愈合的危险因素。结论 应重视BMI<18.4、受累淋巴结≥2枚、并发糖尿病、病灶最大直径≥2.0cm、不规律换药的颈部淋巴结结核换药患者,避免淋巴结结核伤口迁延不愈。

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