{"paper_id":"c64067f6-d6ee-4d91-a24c-a39c5f36f779","body_text":"www.ijpsonline.com\nSpecial Issue 7, 2020Indian Journal of Pharmaceutical Sciences\n82\nEffect Evaluation of Sterile Distilled Water in the  \nNursing Process of Patients with Abdominal Incision  \nEndometriosis\nLEI HAN, WEI NA ZHANG, MIN XU, ZHI QIN TONG AND YA JUAN PAN*\nDepartment of Operation, Haian people’s Hospital, No. 17, Zhongba Middle Road, Hai’an, Nantong, Jiangsu 226600, China  \nHan et al.: Evaluation of sterile distilled water in patients with abdominal incision endometriosis\nTo explore the value of sterile distilled water in the care of patients with endometriosis in abdominal \nwall incision.120 patients who underwent cesarean section under combined lumbar and rigid anesthesia \nin our hospital from August 2017 to January 2018 were selected as study subjects, and all patients were \ntreated surgically, and were randomly divided into three experimental groups according to their nursing \ntreatment after surgery, control group I (n=40): using saline rinse; control group II (n=40): using 0.5 % \npovidone-iodine rinse; experimental Group (n=40): sterile distilled water rinses were used. Observation \nand comparison of patients’ pain status before and after care, quality of life after care and satisfaction \nwith care and the occurrence of complications. The pain and quality of life scores of the three groups of \npatients before nursing were not significantly different, and after nursing, the pain of patients in all groups \nwas reduced, and the pain and quality of life of patients in the control II group and the test group were \nsignificantly reduced compared with the control I group (p<0.05), and there was a significant difference \nin the quality of life comparison between the control II group and the experimental group (p<0.05), while \nthe difference in pain was not statistically significant (p>0.05). After care, the satisfaction of patients in \nthe control II group and the test group was significantly higher (p<0.05) compared to the control I group, \nand the test group had the highest satisfaction, but the difference between the control II group and the \nexperimental group was not statistically significant (p>0.05). Compared with the control I group, patients \nin the control II and test groups had significantly lower complication rates, but the difference between \nthe control II and experimental groups was not statistically significant (p>0.05). The application of sterile \ndistilled water rinsing in the care of patients with abdominal wall incision endometriosis can reduce the \npain and alleviate the suffering of patients, while also effectively preventing complications and helping to \nshorten the recovery process. \nKey words: Endometriosis, abdominal wall incision, sterile distilled water, care\n*Address for correspondence\nE-mail: zxcv24153589@163.com\nEndometriosis (EMS) is a common gynecological \ndisease in which the growth function of endometrial \nglands and stroma occurs in other parts of the uterus. \nAlthough the pathological process is benign, it has the \nability to attack, implant and distant metastasis similar \nto malignant tumor cells, with an incidence rate of 8 \n-15 %[1]. Abdominal incision endometriosis (AIEM), as \na kind of endometriosis, is a special part of endometriosis, \nthe incidence is about 0.03 % - 1.73% [2]. Cesarean \nsection because of abdominal wall incision and uterine \nincision near parallel, close position, endometrial \nimplantation opportunities. Therefore, AIEM secondary \nto cesarean section (about 90 %) is one of the main \nlong-term complications after cesarean section [3]. At \npresent, most studies have found that iatrogenic \nendometrial implantation caused by surgical procedures \nis a key factor in the occurrence of AIEM[4]. Therefore, \nstandardized cesarean section and careful cleaning of \nincision are important preventive measures to prevent \nthe occurrence of AIEM [5,6]. Studies have shown that \nincision irrigation can significantly reduce the number \nof endometrial debris on uterine incision, which is a \nsimple and effective measure to prevent AIEM, and has \nbeen widely recognized and applied by the medical \ncommunity[7]. At present, normal saline [8] and 0.5 % \npovidone iodine[9] are commonly used to prevent AIEM. \nAlthough a large amount of normal saline washing can \nremove the fallen cell debris and prevent the occurrence \nof AIEM[10]. However, a large amount of washing can \ncause pressure on the incision and repeated friction, \nwhich will affect the healing of the wound. It can also \nmake the bed sheet moist, bacteria breed and moderate \n\nwww.ijpsonline.com\nSpecial Issue 7, 2020 Indian Journal of Pharmaceutical Sciences\n83\namount of reduce body temperature probably by \nresetting the hypothalamus[11]. Sterile distilled water, a \nkind of low permeability liquid without any impurities \nand visible components, has been widely used to \nprevent tumor local spread and metastasis. Previous \nstudies have found that the application of distilled water \nin breast cancer surgery is safe and effective, which is \nconducive to wound healing, but there are few reports \non its application in AIEM [12]. Therefore, this study \nintends to explore the application value of sterile \ndistilled water in the nursing care of patients with \nabdominal incision endometriosis. A total of 120 \npatients with cesarean section under combined spinal \nepidural anesthesia from August 2017 to January 2018 \nwere selected as the research objects. Inclusive criteria: \nlower segment cesarean section with transverse incision \nunder combined spinal epidural anesthesia; primipara; \nno history of dysmenorrhea and endometriosis before \npregnancy; no patients with basic diseases such as \npregnancy induced hypertension and gestational \ndiabetes mellitus. Exclusion criteria: patients with \nhistory of iodine allergy; patients with mental history or \ndifficult to communicate with each other and unwilling \nto participate; those without complete cases and follow-\nup data. According to the principle of randomized \ncontrolled grouping, the patients were randomly divided \ninto three groups: control group I (n=40): washed with \nnormal saline; control group II (n=40): washed with 0.5 \n% povidone iodine; experimental group (n=40): washed \nwith sterile distilled water. Statistical analysis showed \nthat there was no significant difference in age, course of \ndisease, incision type and average weight among the \nthree groups (p>0.05), as shown in Table 1. All the \nthree groups were operated by the same group of \ndoctors, and the standardized operation of prevention \nof AIEM was strictly carried out during the operation: \ngauze was used to protect the incision area of abdominal \nwall after routine abdominal incision; amniotic fluid \nand blood were quickly sucked after uterin e incision; \nhand contact was not allowed for wiping the gauze in \nuterine cavity; gloves, surgical instruments, suture \nthread, gauze and suction head were changed before \nclosing the peritoneum. In the experimental group, the \nabdominal incision was washed with distilled water, \nand the specific steps were as follows: first, the surgical \nfilm was applied to the left edge of the incision, parallel \nto the longitudinal axis of the patient’s body. The water \nbag is naturally drooping and knotting along the edge of \nthe operating table to collect flushing fluid. Secondly, \nput the “s” hook under the incision side (both left and \nright sides, subject to the convenience of the operator), \nand press the side of the hook down slightly to make it \nat the lowest point. Pour 200 ml of normal temperature \nflushing solution from top to bottom to completely \nsubmerge the surgical incision. Use the retractor to \nblock the poured water at the incision for 5 min. In \ncontrol group I, abdominal incision was washed with \nnormal saline. In control group II, 0.5 % povidone \niodine was used to wash abdominal incision, and the \noperation procedure was basically the same as that of \nthe experimental group. The pain status of patients \nbefore and after nursing was compared. The visual \nanalogue scale (V AS) was used to evaluate the pain \nstatus, which was divided into 0-10 points, of which 0 \npoints were painless and 10 points were severe pain. \nThe quality of life of patients before and after nursing \nwas compared. SF-36 scale was used to evaluate the \nquality of life, including physical function, emotional \nfunction, physical pain, social function and general \nhealth. The total score is 100 points, and the higher the \nscore, the higher the quality of life. The patients’ \nsatisfaction with nursing work was compared before \nand after nursing. The form of anonymous questionnaire \nwas used, including nursing attitude and nursing \ncontent. The full score was 30 points, 15 questions for \neach item, and the total score was more than 24 points. \nThe incidence of complications, including pain, wound \ninfection, tachycardia. Before nursing, all patients in \nthe three groups had moderate pain. After nursing, the \npain of all groups was reduced, and compared with \ncontrol group I, the pain of control group II and \nexperimental group was significantly reduced (p<0.05), \nbut there was no significant difference between control \ngroup II and experimental group (p>0.05) as shown in \nfig. 1. There was no significant difference in the quality \nof life among the three groups. After nursing, the quality \nFactors Normal saline group Distilled water group 5 % povidone iodine group x2 p value\nAge (y) 32.1±2.3 32.3±1.8 32.2±2.5 0.945 0.977\nCourse of disease (mon) 18.7±3.6 19.4±3.1 18.4±2.7 1.055 0.905\nType of incision\n0.968 0.940Transverse incision 17 19 20\nLongitudinal incision 23 21 20\nweight 52.99±2.23 53.17±2.20 53.05±2.40 1.120 0.875\nTABLE 1: COMPARISON OF GENERAL CLINICAL DATA\n\nwww.ijpsonline.com\nSpecial Issue 7, 2020Indian Journal of Pharmaceutical Sciences\n84\nsection. In recent y, the incidence rate of AIEM has also \nincreased significantly due to the increase of cesarean \nsection rate. Most scholars believe that iatrogenic \nendometrial implantation is the key factor of AIEM [16]. \nIn the process of cesarean section, active endometrial \ncells are directly planted in the surgical wound, and \neventually develop into scar endometriosis [17]. Ectopic \nto the incision endometrium tissue can occur periodic \nbleeding with the periodic changes of ovarian hormone, \naccompanied by fibrous tissue hyperplasia and adhesion \nformation, resulting in pain, mass, periodic abdominal \nincision mass enlargement and menstrual pain, which \noften brings pain to patients. Incision irrigation, as a \nsimple and effective measure to prevent AIEM, can \nsignificantly reduce the number of endometrial debris \non uterine incision, which has been widely recognized \nand applied by the medical community [9]. At present, \nnormal saline and 0.5 % povidone iodine are commonly \nused to prevent AIEM[11]. The normal saline has a basic \nproperty that can inhibit the bacterial growth, sometimes \nas bactericidal with the rise in its concentrations. The \npurpose of washing the wound surface with normal \nsaline is to use the floating and fluidity of the liquid to \nremove the foreign bodies and falling tissue fragments \non the surface of the incision, so that there is no free \nmatter on the surface of the wound, so as to achieve the \npurpose of cleaning[12]. Studies have shown that a large \nnumber of normal saline washing can remove the fallen \ncell debris and prevent the occurrence of AIEM [13]. \nHowever, a large number of washing can cause pressure \non the incision and repeated friction, which will affect \nthe wound healing, and also make the bed sheet moist, \nbacteria breeding, and temperature reduction [14]. \nPovidone iodine is a kind of surfactant with strong \nadhesion. When it contacts the mucosa, it gradually \ndecomposes and slowly releases active iodine, which \ndestroys the protein and enzyme of the bacteria, and the \nmetabolism of the offspring will be blocked and die[15,16]. \nof life of all groups of patients were improved, and \ncompared with control group I, the pain of control \ngroup II and experimental group was significantly \nreduced (p<0.05), and the difference between control \ngroup II and experimental group was markedly \nsignificant (p<0.05), as shown in fig. 2. After nursing, \nthe satisfaction of patients in the control group II and \nthe experimental group was significantly higher than \nthat in the control group I (p<0.05), and the satisfaction \nof the experimental group was the highest, but there \nwas no significant difference between the two groups \n(p>0.05), as shown in fig. 3. Compared with control \ngroup I, the incidence of complications in control group \nII and experimental group was significantly lower than \nthat in control group, but there was no significant \ndifference between control group II and experimental \ngroup (p>0.05), as shown in fig. 4. Pregnant women \nwith a history of cesarean section, and with the \nfollowing performance, should first think of abdominal \nwall endometriosis: typical menstrual cycle, abdominal \nwall incision scar pain, combined with painful nodules \nor masses, menstrual mass enlargement, pain \naggravation, after menstrual mass reduction, pain relief \nor relief[13-15]. IEM, a relatively rare complication after \ncesarean section is secondary to 2-4 y after cesarean \nFig. 1: Comparison of pain before and after treatment in three \nresearch groups\nFig. 2: Changes in quality of life of the three experimental groups before and after treatment\n\nwww.ijpsonline.com\nSpecial Issue 7, 2020 Indian Journal of Pharmaceutical Sciences\n85\nUsing this characteristic to make endometrial cells \ndegenerate and necrosis prevent the occurrence of \nendometriosis. Balin et al. found that the proliferation \nactivity of human skin fibroblasts cultured in vitro with \ndifferent concentrations of povidone iodine decreased \nwith the increase of povidone iodine concentration, and \npromoted cell apoptosis, suggesting that povidone \niodine is toxic to human skin fibroblasts and may affect \nwound repair [17,18]. Chen Tao, et al. also found that \nrepeated immersion and washing with 0.5 % povidone \niodine solution during the operation will form a \nchemical burn on the soft tissue and mucosa in the knee \njoint, causing inflammatory reaction of surrounding \ntissues, which is not conducive to wound healing [19]. \nTherefore, it is suggested that we should be careful \nwhen using povidone iodine for incision irrigation. \nSterile distilled water, a kind of low permeability liquid \nwithout any impurities and visible components, has an \nosmotic pressure of about zero, while the cell osmotic \npressure of normal human tissues is generally 280-310 \nosm. Therefore, there is a large difference in osmotic \npressure between the two. If the cell is in a hypotonic \nenvironment, there will be a certain osmotic pressure \ndifference between the inside and outside of the cell. At \nthis time, the hypotonic solution can enter the cell \nthrough the cell membrane, causing direct swelling, \ndissolution and breakage of the cell and the number of \ndamaged cells will continue to increase with the \ndecrease of osmotic pressure [20]. Distilled water \nirrigation has been widely used in clinic to prevent local \nspread and metastasis of tumor. Studies have shown \nthat the application of distilled water in breast cancer \nsurgery is safe and effective, which is conducive to \nwound healing. In addition, the application of distilled \nwater immersion washing can inactivate tumor cells \nand prevent infection through physical flushing [21]. In \nthis study, the pain and quality of life of patients treated \nwith sterile distilled water were significantly improved \ncompared with the control group, suggesting that sterile \ndistilled water can improve the quality of nursing in the \noperating room, and give patients safe and reliable \ntreatment. Meanwhile, in terms of treatment satisfaction \nand psychological state evaluation, patients in the \nexperimental group were significantly higher than the \nother two groups, which showed that sterile distilled \nwater can give patients better treatment experience and \nenhance their confidence in treatment and rehabilitation. \nIn addition, in the treatment of complications, the \nproportion of patients in the experimental group is the \nsmallest and the degree is the lightest, which indicates \nthat sterile distilled water can effectively and quickly \ncontrol the side effects in the treatment process, reduce \nunnecessary medical disputes and the economic burden \nof patients. In conclusion, the application of sterile \ndistilled water in the nursing care of patients with \nendometriosis of abdominal incision can reduce the \npain and pain of patients, and effectively prevent \ncomplications, which is conducive to shorten the \nrehabilitation process.\nAcknowledgement:\nThis work was supported by the foundation of \nNantong Science and Technology Bureau Project (No. \nYYZ17054). \nDeclaration of interest:\nThe authors report no conflicts of interest.\nREFERENCES\n1. Bowes H, Jones G, Thompson J, Wood H, Hinchliff S, Ledger \nW, et al. Understanding the impact of the treatment pathway \nupon the health-related quality of life of women with newly \ndiagnosed endometrial cancer-A qualitative study. Eur J Oncol \nNurs 2014;18:211-7. \n2. Marsden NJ, Wilson-Jones N. Scar endometriosis: A rare \nskin lesion presenting to the plastic surgeon. J Plast Reconstr \nAesthet Surg 2013;66:e111-3. \n3. Leng J, Lang J, Guo L, Li H, Liu Z. Carcinosarcoma arising \n \nFig. 3: Investigation on treatment satisfaction of three research \ngroups\nFig. 4: Comparison of complications in the treatment of three \nresearch groups\n\nwww.ijpsonline.com\nSpecial Issue 7, 2020Indian Journal of Pharmaceutical Sciences\n86\n14. Ma YQ, Feng XX, Wang LW. Observation on the healing effect \nof subcutaneous irrigation on abdominal surgical incision in \nobstetrics and gynecology. Chin J Clin Res 2003;8:11974-5.\n15. Ba JB, Liu YM, Yin M. Progress in the study of the \nphysicochemical properties of povidone iodine and its \ndisinfection applications. J Chin Disinfec 2009;26:548-50.\n16. Liu YF, Zhao JM, Bai TC. Prevention of peritoneal \nimplantation metastasis of gastric cancer by intraperitoneal \nlavage during povidone-iodine surgery. Chin J Mod General \nSurgery 2011;14:242-3.\n17. Balin AK, Pratt L. Dilute povidone iodine solutions inhibit \nhuman skin fibroblast growth. Dermatol Surg 2002;28:210-4.\n18. Yang GS, Zhang R, Feng YQ. Effect of different iodine \npreparations on the adhesion and proliferation of human skin \nfibroblasts. Chin J Mod Med 2010; 20:346-9.\n19. Chen T, Shang XF, He R. Effect of iodophor flushing on \nincision and functional recovery after total knee replacement \nsurgery. Clin Orthop 2011, 14(6): 697-699.\n20. Guo GZ, Jia WJ. The use of tumor-free technique in radical \nbreast cancer surgery. Chin General Nursing 2008, 6(10): \n2792-2793.\n21. Yi ZF, Zhu BR. The effect of warm distilled water for wound \nirrigation in breast cancer surgery. Chin Med Innov 2011, \n10(30): 107-108.\nfrom atypical endometriosis in a cesarean section scar. Int J \nGynecol Cancer 2006;169:432-5. \n4. Kuhn PJ, Threlfall DR. Biosynthesis and metabolism of \nsesquiterpenoid phytoalexins and triterpenoids in potato cell \nsuspension cultures. Phytochemistry 1988;27:133-50.\n5. 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Endometriosis of the abdominal wall \nincision after cesarean section the preventive care measures. \nZhejiang Med 2013;16:964-5.\n11. Wang GX, Ren QZ, Jiang XL. Prevention of endometriosis \nwith povidone-iodine in abdominal wall incision. J Tradit Chin \nMed 2013; 35:181-2.\n12. Yu YJ, Sun SH, Geng SK. Study on the appropriate dosage \nof saline solution for wound rinsing in wound debridement \nsurgery. Chinese Journal of Disability Medicine 2010;18:3-4.\n13. Xiang Y . Report of 15 cases of abdominal wall incision for \nendometriosis. Chin J Obstet Gynecol 1991;26:303.\nThis article was originally published in a special issue,  \n“Biomedical  Research in Clinical and Preclinical  \nPharmaceutics” Indian J Pharm Sci 2020:82(5)Spl issue7;82-86\nThis is an open access article distributed under the terms of the Creative \nCommons Attribution-NonCommercial-ShareAlike 3.0 License, which  \nallows others to remix, tweak, and build upon the work non-commercially,  \nas long as the author is credited and the new creations are licensed under \nthe identical terms","source_license":"CC0","license_restricted":false}