| Objective:By retrospectively analyzing the clinical data of inpatients with chronic refractory wounds in the Department of Burn in the First Affiliated Hospital of Nanchang University in recent 6 years,this study provided a reference for the epidemiological study and prevention of chronic refractory wounds.Method:Clinical data of inpatients with chronic refractory wounds in the burn department of the First Affiliated Hospital of Nanchang University from January 1,2015 to December 31,2020 were included.The epidemiological characteristics were analyzed including basic information(gender,age,place of residence),course of wound disease,combined basic diseases,cause of wound formation,site of wound,bacterial etiology,length of hospital stay,cost of hospital stay,treatment methods and outcome of curative effect.Results:1.A total of 1502 patients with chronic refractory wounds were included in this study,including 966 males(64.3%)and 536 females(35.7%),with a male-to-female ratio of 1.80:1;The minimum age was 3 months,the maximum was 95 years,and the average age was 56.00(44.00,69.00)years.There were 322 cases(21.44%)aged 50to 59 years old,followed by 296 cases(19.71%)aged 60 to 69 years old.There were more male patients than female patients in each age and sex distribution.There was no statistical significance in the number of cases between male and female in each age group(?~2=7.844,P=0.449).There were 973 rural patients(64.8%)and 529 urban patients(35.2%).The ratio of rural patients to urban patients was 1.84:1.A total of977 patients(65.05%)with underlying diseases,a total of 1540 cases,The common basic diseases were diabetes mellitus 487 times(31.62%),hypertension 373 times(24.22%),paraplegia 152 times(9.87%),old cerebral infarction 95 times(6.17%),and coronary atherosclerotic heart disease 64 times(4.16%).The overall number of patients with the disease from 2015 to 2020 showed an increasing trend year by year,and there was no statistical significance in the gender composition of the average annual population(?~2=7.025,P=0.219).2.The clinical features of 1502 cases of chronic refractory wounds in this study:The main types were metabolic ulcer in 411 cases(27.36%),followed by traumatic ulcer in 327 cases(21.77%),pressure injury ulcer in 278 cases(18.51%),infectious ulcer in 135 cases(8.99%),iatogenic ulcer in 103 cases(6.86%),scar ulcer in 95 cases(6.32%).There were 68 cases of vascular ulcer(4.53%),47 cases of malignant ulcer(3.13%),and 38 cases of others(2.53%).Most of the patients with different types of chronic refractory wounds were male,and there was a statistically significant difference in the number of patients with different types of chronic refractory wounds(?~2=15.926,P=0.043).There was statistical significance in the types of chronic refractory wound ulcers compared with the number of cases in different ages(P<0.05).There was statistically significant difference in the distribution of types of chronic refractory wounds in 6 years(?~2=142.789,P<0.05).There were 1812 sites of chronic refractory wounds,including 1090(60.15%)in lower extremities,339(18.71%)in buttocks and perineum,126(6.95%)in upper extremities,88(4.86%)in head,face and neck,86(4.75%)in chest and abdomen,and83(4.58%)in lumbar and back.Chronic refractory wounds are most common in lower extremities.Distribution of pathogenic bacteria in chronic refractory wound:A total of805 strains were isolated and cultured,including 517 strains of Gram-negative bacteria(64.23%),271 strains of Gram-positive bacteria(33.66%)and 17 strains of fungi(2.48%).The common flora were 104 strains of Escherichia coli(12.92%),99strains of Pseudomonas aeruginosa(12.30%),81 strains of Proteus singular(10.06%)and 130 strains of Staphylococcus aureus(16.15%).Treatment methods and efficacy outcomes:Among the 1502 patients,852 cases(56.73%)healed,514 cases(34.22%)improved and 136 cases(9.05%)did not heal after treatment.Among them,281 cases(17.08%)healed,118 cases(41.99%)improved and 115 cases(40.93%)did not heal after conservative treatment.In the uncured patients,more than half of them chose automatic discharge or refused surgical treatment.In 1221 cases,804 cases(65.85%)were cured,396 cases(32.43%)were improved,and 21 cases(1.72%)were not cured.The healing rate of chronic refractory wound surgery was higher than that of conservative treatment,and debridement skin transplantation,skin flap transplantation,artificial dermal transplantation combined with negative pressure wound therapy(NPWT)and platelet-rich plasma(PRP)had better adjuvant treatment effect.3.Duration of hospitalization and cost of chronic refractory wound patients:The hospitalization time of 1502 patients with chronic refractory wound in this group was30.00(18.00,46.00)days,and the hospitalization cost was 39,832.43(22,189.66,67,451.31)yuan.The hospitalization time of pressure injury ulcer was the longest40.00((21.00,62.25)days,the hospitalization cost of other types was the most58469.87(25431.39,136598.14)yuan,and the hospitalization time of malignant ulcer was the shortest 21.00(9.00,38.00)days.The hospitalization cost is at least 23,115.10yuan(7,374.12,48,328.72).There were statistically significant differences in the length of stay and the cost of hospitalization among all types of chronic refractory wound patients(?~2=78.109,102.798,P<0.05).Conclusion:1.Population distribution characteristics of inpatients with chronic refractory wound:the majority of inpatients were male,middle-aged and elderly,and rural population,and the number of patients increased year by year from 2015 to 2020.2.wound formation with metabolic,traumatic,pressure resistance,infection is given priority to,the wound area with the most common lower limbs,different types in patients with chronic wound painless sex gender differences,all ages,s distribution,six years of chronic painless wound type distribution differences obviously,different types of different length of hospital stay and cost of hospitalization of the wound.3.Gram-negative bacteria were the main pathogenic bacteria in chronic refractory wound.Staphylococcus aureus,Escherichia coli,Pseudomonas aeruginosa,Proteus singular,and Bauman/Acinetobacter hemolyticus were found to have a high detection rate of pathogenic bacteria on wound surface.4.In the treatment of patients with chronic refractory wounds,the first thing to consider is to treat the etiology,control the underlying diseases and improve the systemic condition,and strengthen local cleaning and dressing change of the wounds.Secondly,simple and easy surgical methods should be selected,and the most favorable and effective treatment methods should be selected in combination with the patient’s wound conditions and economic basis. |
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