Epidemiological Investigation And Analysis Of Chronic Refractory Wound In Tropical Island

Objective:To analyze the epidemiological characteristics of chronic refractory wounds in tropical islands and understand the changes of bacterial structure spectrum under the special ecological environment(high temperature,high humidity,high salt,and rich oxygen)in this island and the influence of different treatment methods on the curative effect of patients with chronic refractory wounds,it provides reference data for the treatment of chronic refractory wounds in tropical islands,and to improve the quality of life of patients and alleviate the pressure of national medical insurance funds.Methods:The epidemiological characteristics of chronic refractory wound in hospitalized patients from 0:00 on January 1,2016 to 0:00 on December 31,2019.were collected in the First Affiliated Hospital of Hainan Medical University,the Second Affiliated Hospital of Hainan Medical University and the Affiliated Hospital of Hainan Medical University on the tropical island.Then analyze the age,gender,ethnicity,occupation,etiology,wound site,secretion culture results,patient’s residence(urban or suburban including rural areas),length of hospital stay,cost of treatment,treatment method and outcome of chronic refractory wound patients.Results:(1)The data of chronic refractory wound of 2904 patients were collected in tropical islands,including 1836 males(63.22%)and 1068 females(36.78%).The male to female ratio was 1.8:1.Among them,30.75%were from 41 to 60 years old,38.74%were from 61 to 80 years old,and 14.39%were from 81 to 100 years old.(2)There were 867 urban patients with chronic wounds,accounting for 29.86%,1761suburban(rural)patients,accounting for 60.64%,2628 in island patients,accounting for 90.50%,and 9.50%out of island patients.There were 2,057 cases of Farmers,accounting for 70.83%,and 368 cases of retired cadres,accounting for 12.67%.The main source of chronic refractory wound is farmers,followed by retired cadres.(3)In this island,diabetic foot accounted for 46.01%,bedsore accounted for 18.22%and wound infection accounted for 16.18%.(4)80.82%of the patients were in the extremities,of which the lower limbs and feet were the most common,and the lumbosacral caudal patients accounted for 13.12%,which was the second most common site of chronic refractory wounds in this island.(5)About 90%of the patients underwent secretions bacterial culture,and 1740 bacterial strains,66 kinds of microorganisms and 661 strains of G~+bacteria were obtained,accounting for about37.99%of the bacterial colonies,and 981 strains of G~-bacteria,accounting for about56.38%of the bacterial colonies.There were 293 strains of Staphylococcus aureus in G~+bacteria,accounting for 16.84%,198 strains of Pseudomonas aeruginosa in G~-bacteria,accounting for 11.38%,and 42 strains of Candida albicans in fungi,accounting for 2.41%.(6)1549 patients with chronic wound in this island received conservative treatment,and the healing rate was 72.18%.1355 cases were treated by surgery,and the healing rate was 85.68%.The prognosis of patients receiving conservative treatment or surgical treatment for this type of wound was statistically significant(X~2=78.07,P<0.01).(7)The average hospitalization cost for skin pressure ulcers was about 32297.84 yuan,the average hospitalization cost for infectious wounds was about 24401.46 yuan,and the average hospitalization cost for diabetic foot was about 21460.78 yuan.(8)The mean hospitalization time of pressure ulcers patients was about 27.06±26.71 days,and that of wound/postoperative infection patients was about 21.27±17.17 days.Diabetic foot infection was 20.04±14.42 days.The mean length of hospital stay for burns and scalds was the shortest.Kruskal-Wallis Test was performed for the length of hospital stay of patients with chronic refractory wound caused by different etiologies,and the difference was statistically significant(Hc=37.97,P<0.01).Conclusion:(1)The majority of chronic refractory wounds in this island are farmers,followed by retired cadres.(2)The age of onset was mostly 61-80 years old,with more males than females,mainly patients from Hainan,and the increase in the past two years.(3)The main etiology of this type of wound was diabetic foot,followed by pressure sores and wound/post-operative wound infection,and malignant ulcer was a rare cause.Patients with pressure sores had the highest cost of treatment,followed by soft tissue infection,wound/postoperative incision infection,and diabetic foot.(4)The most common site of this kind of wound was the extremities,and the single wound was mainly in the lower limbs and feet,while multiple wounds were rare.(5)The main pathogenic bacteria of this kind of wound were G~-bacteria,with the largest number of Pseudomonas aeruginosa,followed by Citrobacter genus,Enterobacter cloacae and Escherichia coli.Staphylococcus aureus was the main G~+bacteria,followed by streptococcus.The fungi were mainly Candida albicans.(6)The number of patients with this type of wound under conservative treatment is equal to that under surgical treatment,but the overall effect of surgical treatment is better than that of conservative treatment.Simple debridement and VSD surgery can promote wound healing,among which skin grafting has the best effect.