单中心结核性创面与非结核性慢性难愈性创面患者的特点

Characteristics of patients with tuberculous wounds and non-tuberculous chronic refractory wounds in single center

目的探讨单中心中结核性创面与非结核性慢性难愈性创面患者的特点。方法2010年1月-2017年6月,将解放军总医院第八医学中心烧伤整形科收治的符合入选标准的43例结核性创面患者、44例非结核性慢性难愈性创面患者分别纳入结核性创面组和非结核性创面组,回顾性分析其临床资料。统计2组患者的性别、居住地、外伤史、创面形成时间、创面确诊时间、住院次数、住院时间,年龄,创面部位,创面面积、窦道发生情况、换药次数、手术次数、行负压封闭引流(VsD)治疗情况、痊愈情况,医疗费用来源,社会基本医疗保险和自费负担各项费用情况。对数据行独立样本t检验、x^2检验。结果(1)除性别(x^2=0.019,P>0.05)外,结核性创面组和非结核性创面组患者居住地、外伤史、创面形成时间、创面确诊时间、住院次数、住院时间比较,差异均有统计学意义(x^2=4.535、27.651,t=7.252、16.131、4.663、7.416,P<0.05或P<0.01)。(2)结核性创面组和非结核性创面组患者年龄段构成比比较,差异无统计学意义(x^2=11.522,P>0.05)。(3)结核性创面组患者创面多见于胸部,非结核性创面组患者创面多见于下肢。2组患者创面部位构成比比较,差异有统计学意义(x^2=28.450,P<O.01)。(4)结核性创面组和非结核性创面组患者创面面积、窦道发生情况、换药次数、手术次数比较,差异有统计学意义(t=-8.524、9.846、-15.426、4.663,P<0.01);2组患者行VsD治疗情况、痊愈情况比较,差异元统计学意义(x^2=0.032、0.111,P>0.05)。(5)结核性创面组患者中医疗费用来自社会基本医疗保险、公费、自费及军队医疗者分别占48.8%(21/43)、7.0%(3/43)、39.5%(17/43)、4.7%(2/43),非结核性创面组患者中医疗费用来自社会基本医疗保险、公费、自费及军队医疗者分别占59.1%(26/44)、4.5%(2/44)、29.5%(13/44)、6.8%(3/44)。2组患者医疗费用来源构成比比较,差异无统计学意义(x^2=1.154,P>0.05)。(6)结核性创面组和非结核性创面组患者由社会基本医疗保险和自费负担的各项费用中,诊疗费、药费、手术费、检查费、化验费、床位费及总费用比较,差异有统计学意义(t=45.051、39.995、64.212、32.584、8.754、43.991、15.671,17.640、65.155、35.546、35.903、-4.329、3.344、12.984,P<0.01)。结论相较于非结核性慢性难愈性创面患者,结核性创面患者创面形成时间长、诊断及治疗难度大、住院时间长,创面多分布于胸部,常伴有窦道形成,医疗费用高;2组患者创面医疗费用均主要由社会基本医疗保险及自费负担。

Objective To explore the characteristics of patients with tuberculous wounds and nontuberculous chronic refractory wounds in single center.Methods From January 2010 to June 2017,43 patients with tuberculous wounds and 44 patients with non-tuberculous chronic refractory wounds admitted to the Department of Burns and Plastic Surgery of the Eighth Medical Center of the General Hospital of the Chinese People's Liberation Army were conforming to.the inclusion criteria.The patients were assigned to tuherculous wound group and non-tuberculous wound group,respectively,and their clinical records were retrospectively analyzed.The gender,place of residence,history of trauma,time of wound formation,time of wound diagnosis,number and length of hospital stay,age,wound site,wound area,sinus occurrence,number of dressing change,number of operation,vacuum sealing drainage (VSD)treatment,recovery,source of medical expense,expense paid by social basic medical insurance and the self-payment of patients in the 2 groups were investigated.Data were processed with independent sample t test and chi-square test.Results (1 )Except for gender (x^2 =0.019,P >0.05),there were significantly statistical differences in place of residence,history of trauma,time of wound formation,time of wound diagnosis,number and length of hospital stay between patients in tuberculous wound group and non-tuberculous wound group (x^2 =4.535, 27.651,t =7.252,16.131,4.663,7.416,P <0.05 or P <0.01 ).(2)There was no statistically significant difference in the composition ratio of age between patients in tuberculous wound group and non-tuberculous wound group (x^2 =11.522,P >0.05 ).(3)The wounds of patients in tuberculous wound group were more common in the chest,and the wounds of patients in non-tuberculous wound group were more common in the lower limbs.There was statistically significant difference in the composition ratio of the wound sites be- tween patients in the two groups (x^2=28.450,P <0.01 ).(4)There were statistically significant differences in wound area,sinus occurrence,number of dressing change,number of operation between patients in tuberculous wound group and non-tuberculous wound group (t =-8.524,9.846,-15.426,4.663,P < 0.01 ).There were no .statistically significant differences in VSD treatment and recovery between patients in the two groups (x^2 =0.032,0.111,P >0.05).(5)The medical expenses of patients in tuberculous wound group from social basic medical insurance,free medical service,the self-paid,and military medical services accounted for 48.8%(21/43),7.0%(3/43),39.5%(17/43 ),and 4.7 %(2/43),respectively.The medical expenses of patients in non-tuberculous wound group from social basic medical insurance,free medical service,the self-paid,and military medical services accounted for 59.1%(26/44), 4.5%(2/44),29.5%(13/44),and 6.8%(3/44),respectively.There was no statistically significant difference in the composition ratio of sources of medical expense between patients in the two groups (x^2 = 1.154,P >0.05).(6)There were statistically significant differences in expenses for diagnosis,medicine, surgery,examination,laboratory test,and bed,and total expenses paid by social basic medical insurance and the self-payment between patients in tuberculous wound group and non-tuberculous wound group (t = 45.051,39.995,64.212,32.584,8.754,43.991,15.671,17.640,65.155,35.546,35.903, -4.329,3.344,12.984,P <0.01).Conclusions Compared with those of patients with non-tubercu lous chronic refractory wounds,the tuberculous wounds of patients have longer formation time,the diagnosis and treatment of the wounds are difficult,their wounds are mostly distributed in the chest and often accompanied by sinus formation,and patients with the wounds have long hospital stay and high medical expenses. Besides,the medical expenses for treating wounds of patients in the two groups are mainly paid by social basic medical insurance and the patients themselves.