新疆地区糖尿病足患者就诊延迟现状及其对治疗结局影响的研究

Current situation research of health-seeking delay and it’s influence on treatment outcome in diabetic foot patients

目的探讨新疆地区糖尿病足(DF)患者就诊延迟的现状及其对治疗结局的影响。方法选取2016年1月至2020年12月于我院烧伤创面修复外科住院的就诊延迟DF患者459例,按照就诊延迟时间分为3~30 d组和>30 d组,比较两组住院时间、住院治疗费用和结局。Pearson相关分析就诊延迟与各指标的相关性。Logistic回归分析就诊延迟的影响因素。结果单因素分析显示,年龄、文化程度、Wagner分级、自行换药、日常生活能力量表评分、人均月收入、居住地与DF患者就诊延迟相关(P<0.05);Pearson相关分析显示,就诊延迟与年龄、Wagner分级呈正相关(r=0.258、0.381,P<0.001或P<0.05),与ADL评分、人均月收入、文化程度呈负相关(r=-0.202、-0.411、-0.301,P<0.001或P<0.05);Logistic回归分析显示,Wagner分级、文化程度及人均月收入是DF患者就诊延迟的主要影响因素(P<0.05)。就诊延迟时间越长,住院时间越长(P<0.001),住院治疗费用越高(P=0.030),治愈及好转率越低(P=0.027),未愈率、截肢率、死亡率越高(P=0.002)。结论新疆地区DF患者就诊延迟普遍存在,诸多因素导致患者就诊延迟,对治疗结局造成负面影响。临床应采用综合性措施加以改善。

Objective To study the current situation and influencing factors of health-seeking delay of diabetic foot(DF)patients and it’s influence on treatment outcome.Methods 459 inpatients with DF was included in this retrospective cohort from January 2016 to December 2020 to study the current situation of health-seeking delay. They were divided into group 3~30 d and group >30 d according to the time of health-seeking delay. Pearson correlation analysis study the correlation between health-seeking delay and various factors. Logistic regression analysis was used to identify the influencing factors.Results Univariate analysis of 459 DF patients showed that age,education level,Wagner grade,self-treatment,ADL score,per capita monthly income and place of residence were associated with health-seeking delay in DF patients(P<0. 05).Pearson correlation analysis showed that health-seekingdelay level was positively correlated with age,and wagner grade(r=0. 258,0. 381,P<0. 01 or P<0. 05)and negative correlated with activities of daily living score,per capita monthly income and educational Level(r=-0. 202,-0. 411,-0. 301,P<0. 001 or P<0. 05). Logistic regression analysis showed that Wagner grade,education and income level were the main factors affecting the health-seeking delay.The longer the health-seeking delay,the longer the hospitalization time(P<0. 001),the higher the medical cost(P=0. 030),the lower the cure rate(P=0. 027),the higher the rateof amputation and death(P=0. 002).Conclusion The phenomenon of health-seeking delayis common among DF patientsin Xinjiang. Visits are limited by multiple factors,which lead to serious adverse outcomes.Targeted strategies are urgently needed to improvethis situation.