889例体表慢性难愈合创面住院患者临床流行病学研究

Clinical epidemiology study of chronic cutaneous wounds: An analysis of 889 inpatients

  • 摘要:
      背景  体表慢性难愈合创面严重影响人们生活质量,为此战略支援部队特色医学中心开设创面修复科,但该中心数据缺乏临床流行病学分析。
      目的  分析战略支援部队特色医学中心体表慢性难愈合创面住院患者的临床流行病学特点。
      方法  回顾性分析2015年1月1日- 2020年12月31日战略支援部队特色医学中心收治住院的889例体表慢性难愈合创面患者的病历资料,分析其流行病学特点。
      结果  889例患者中男性599例,女性290例,男女比为2.1∶1,中位年龄为64(范围13 ~ 93)岁。不同年龄段患者职业分布不同,21 ~ 60岁年龄段以体力劳动者人群为主,60岁以上多为离退休人群。拥有吸烟不良习惯的患者以41 ~ 60岁年龄段最常见。体表慢性难愈合创面合并高血压、糖尿病、心脏病、高脂血症等基础疾病的患病率随年龄增加呈上升趋势,其中61 ~ 80岁年龄段中合并糖尿病的人群比例达90.6%(444/490)。糖尿病(52.5%)为慢性难愈合创面的主要致病原因,其次是动脉性创面(37.6%)。419例(47.1%)进行了创面病原学检查,其中324例检测结果阳性,阳性率为77.3%(324/419);共检测到革兰阳性菌207例,革兰阴性菌158例,真菌10例。外科清创联合应用负压吸引、新型敷料是大部分慢性创面的主要治疗方式,部分病例采取常规换药联合抗炎、促循环等保守治疗方式;少数创面还应用生长因子凝胶、富血小板血浆及高压氧、红外照射等辅助治疗手段。889例中,治愈110例,占12.4%;好转624例,占70.2%;恶化148例,占16.6%;死亡7例,占0.8%,全部死于由感染等因素导致的心肺功能衰竭。749例住院1次,占84.3%;140例重复住院≥2次,占15.7%,其中104例住院2次,25例住院3次,6例住院4次,3例住院5次,2例住院6次。随住院次数增加,患者各次的平均住院时间无明显变化,人均住院费用降低。
      结论  体表慢性难愈合创面患者以中老年人群为主,男性多于女性。糖尿病创面与动脉性创面是该病主要原因。治疗方式以手术为主,截肢/趾率高。该病复发率高,易导致患者多次住院。随住院次数增加,患者每次平均住院时间无明显变化,平均住院费用降低。

     

    Abstract:
      Background  Chronic cutaneous wounds seriously affect the patients’ life quality. In recent years, a special wound repair center has been set up in the Strategic Support Force Medical Center, but clinical epidemiological analysis has not been carried out.
      Objective  To analyze the clinical epidemiological characteristics of inpatients with chronic cutaneous wounds.
      Methods  A retrospective analysis was conducted on 889 patients with chronic cutaneous wounds admitted to the Strategic Support Force Medical Center from January 1, 2015 to December 31, 2020 to analyze its epidemiological characteristics.
      Results  Of the 889 patients, there were 599 males and 290 females, with the male to female ratio of 2.1:1. The median age was 64 years (range: 13 to 93 years). The occupational distribution was different in different age groups. In the age group of 21-60 years, more than half of the patients were manual workers, and in the age group over 60 years, nearly half of the patients were retired. The age group of 41-60 years had the highest prevalence rate of bad smoking habit. The prevalence of comorbidities such as hypertension, diabetes, heart disease and hyperlipidemia increased with age. Among them, 90.6% (444/490) of the patients aged from 61 to 80 years had diabetes. Diabetes mellitus (52.5%) was the main cause of chronic cutaneous wounds, followed by arterial wounds (37.6%). There were 419 cases (47.1%) examined for wound pathology, and the positive rate of pathogen was 77.3% (324/419). Of the 207 Gram-positive bacteria cases, there were 158 Gram-negative bacteria cases and 10 fungi cases. Surgical debridement combined with negative pressure suction and new dressings were the main treatment methods for most chronic wounds. Some cases received conservative treatment such as general dressing change combined with anti-inflammatory and circulation promotion, and some wounds were treated with growth factor, PRP, hyperbaric oxygen and infrared irradiation. Of the 889 cases, 110 cases (12.4%) were cured, 624 cases (70.2%) were improved, 148 cases (16.6%) deteriorated, and 7 cases (0.8%) died of cardiopulmonary failure caused by infection. There were 749 patients hospitalized once, accounting for 84.3%; while the rest 140 cases (15.7%) were hospitalized at least twice, including 104 cases for twice, 25 cases for 3 times, 6 cases for 4 times, 3 cases for 5 times, and 2 cases for 6 times. With the increase of hospitalization times, the average length of stay did not change significantly, but the average hospitalization costs decreased.
      Conclusion   Chronic cutaneous wounds mainly occurs in the middle-aged and senior people, with more male than female. Diabetic wounds and arterial wounds are the main causes of the disease. The main treatment of this disease is surgery, with high amputation rate. It has a high recurrence rate, leading to repeated hospitalization in some patients. With the increase of hospitalization times, the average length of stay does not change significantly, but the average hospitalization costs decrease.

     

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