慢性难愈合创面住院患者回顾性调查

Retrospective investigation of inpatients with chronic wounds

目的 了解慢性难愈合创面形成原因及患者相关情况,为该类创面的治疗、研究提供方向,为国家相关部门制定健康保障策略提供依据.方法收集2008年武汉市第三医院全院共12 161例次住院患者病历资料.以皮肤组织缺损经1个月治疗未愈合为判定标准,筛选出慢性难愈合创面患者病历,回顾性调查患者创面形成原因、性别、年龄、治疗情况、平均住院日.对数据行χ2检验和方差分析.结果 12 161例次住院患者中,慢性难愈合创面患者397例次占3.3%.（1）创面的主要形成原因为烧伤占59.9%（238/397）、糖尿病占15.6%（62/397）、压疮占10.8%（43/397）,其次为手术、感染、静脉曲张等.各种原因引起慢性难愈合创面患者例次比较,差异有统计学意义（χ2=136.21,P=0.001）.（2）慢性难愈合创面患者男、女比例为2.0∶1.0;年龄（44±23）岁,高发年龄段为大于或等于70岁,各年龄段创面患者例次比较,差异有统计学意义（χ2=24.12,P=0.025）.各种原因引起的慢性难愈合创面患者各年龄段例次比较,差异均有统计学意义（χ2值为7.86～28.31,P值均小于0.05）.（3）分别有60.5%（240/397）和86.4%（343/397）的慢性难愈合创面患者接受了手术与抗生素治疗,所有患者均采用传统敷料治疗.（4）慢性难愈合创面患者平均住院日为（38±27）d,较同期所有住院患者明显延长[（15±7）d,F=22.82,P=0.012].烧伤引起的慢性难愈合创面患者平均住院日[（47±27）d]最长,各种原因引起的慢性难愈合创面患者平均住院日比较,差异有统计学意义（F=24.06,P=0.036）.结论烧伤及糖尿病引起的慢性难愈合创面较多,创面患者老龄化明显、住院时间明显长于其他疾病患者.有必要加大转化医学研究力度,促进国家相关政策制定,使慢性难愈合创面得到科学合理的治疗.

Objective To investigate cause of chronic wounds and related status of patients so as to provide strategy for study and treatment of chronic wounds and establish ment of health policy. Methods A total of twelve thousand one hundred and sixty-one cases hospitalized in our hospital in 2008 were enrolled in the study. A chronic wound was defined as skin tissue defect which could not heal after one month of treatment. Medical records were thus screened. Then a retrospective study was performed on patients with chronic wounds with analysis of age, gender, injury cause, therapy, and average length of hospital stay. Data were processed with chi-square test and one-way analysis of variance. Results Investigation showed：397 out of 12 161 cases （ accounting for 3.3% ） were recognized as having chronic wounds. （ 1 ） The main causes for chronic wound were burn, diabetes, and pressure ulcer, accounting for 59.9% （238/397）,15.6% （62/397）, 10.8% （43/397）, respectively. The other causes were operative injury, infection,varicosity, etc. There was statistical difference among the numbers of patients with chronic wounds with regard to various causes of injury （x 2 = 136.21, P = 0. 001 ）. （2） Among patients with chronic wound, the patients older than 70 years. There was significant difference in the numbers of patients with chronic wound among different age groups （x2 = 24.12, P =0. 025）. There was statistical difference among the numbers of patients with chronic wound in different age groups with each cause of injury （ with x 2 values from 7.86 to 28.31, P values all below 0.05 ）. （ 3 ） All patients with chronic wounds received traditional dressing. In 60. 5% （240/397） and 86.4% （343/397） of patients, operative treatment or antibiotics were given. （4）The average length of hospital stay in patients with chronic wound [（ 38 ± 27 ） d] was longer as compared with that of all the inpatients in the same period [（15 ± 7） d, F = 22.82, P = 0. 012]. There was obvious difference in the average length of hospital stay among patients with chronic wound caused by different reasons （ F = 24.06, P = 0. 036） , in which burn injury resulted in the longest length of hospital stay [（47 ±27） d]. Conclusions Chronic wounds are mainly caused by diabetes and burn, and characterized by old age and longer length of hospital stay. It is necessary to strengthen translational research and related policy making, so that more rational treatment can be applied for patients with chronic wounds.