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[单中心结核性伤口与非结核性慢性难治性伤口患者的特征]

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

作者信息

Rong M Y, Jia C Y

机构信息

Graduate School, Hebei North University, Zhangjiakou 075000, China (Rong Meiyu is now working at the Department of Burns and Plastic Surgery, the Eighth Medical Center of PLA General Hospital, Beijing 100091, China).

Department of Burns and Plastic Surgery, Xiang'an Hospital of Xiamen University, Xiamen 361102, China.

出版信息

Zhonghua Shao Shang Za Zhi. 2019 Feb 20;35(2):90-94. doi: 10.3760/cma.j.issn.1009-2587.2019.02.003.

Abstract

To explore the characteristics of patients with tuberculous wounds and non-tuberculous chronic refractory wounds in single center. 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 tuberculous 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 test and chi-square test. (1) Except for gender ((2)=0.019, >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 ((2)=4.535, 27.651, =7.252, 16.131, 4.663, 7.416, <0.05 or <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 ((2)=11.522, >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 between patients in the two groups ((2)=28.450, <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 (=-8.524, 9.846, -15.426, 4.663, <0.01). There were no statistically significant differences in VSD treatment and recovery between patients in the two groups ((2)=0.032, 0.111, >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 ((2)=1.154, >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 (=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, <0.01). Compared with those of patients with non-tuberculous 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.

摘要

探讨单中心结核性创面与非结核性慢性难愈创面患者的特点。选取2010年1月至2017年6月在中国人民解放军总医院第八医学中心烧伤整形科住院的43例结核性创面患者和44例非结核性慢性难愈创面患者,均符合纳入标准。将患者分别分为结核性创面组和非结核性创面组,对其临床资料进行回顾性分析。调查两组患者的性别、居住地、外伤史、创面形成时间、创面诊断时间、住院次数及住院时间、年龄、创面部位、创面面积、窦道形成情况、换药次数、手术次数、负压封闭引流(VSD)治疗情况、愈合情况、医疗费用来源、社会基本医疗保险支付费用及患者自付费用等。数据采用独立样本t检验和卡方检验进行处理。(1)除性别外(χ²=0.019,P>0.05),结核性创面组与非结核性创面组患者在居住地、外伤史、创面形成时间、创面诊断时间、住院次数及住院时间方面差异有统计学意义(χ²=4.535、27.651、7.252、16.131、4.663、7.416,P<0.05或P<0.01)。(2)结核性创面组与非结核性创面组患者年龄构成比差异无统计学意义(χ²=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。两组患者创面部位构成比差异有统计学意义(χ²=28.450,P<0.01)。(4)结核性创面组与非结核性创面组患者在创面面积、窦道形成情况、换药次数、手术次数方面差异有统计学意义(t=-8.524、9.846、-15.426、4.663,P<0.01)。两组患者VSD治疗情况及愈合情况差异无统计学意义(χ²=0.032、0.111,P>0.05)。(5)结核性创面组患者社会基本医疗保险、公费医疗、自付、军队医疗支付费用占比分别为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社会基本医疗保险、公费医疗、自付、军队医疗支付费用占比分别为59.1%(26/44)、4.5%(2/44)、29.5%(13/44)、6.8%(3/44)。两组患者医疗费用来源构成比差异无统计学意义(χ²=1.154,P>0.05)。(6)结核性创面组与非结核性创面组患者社会基本医疗保险及自付的诊断、药费、手术费、检查费、检验费、床位费及总费用差异有统计学意义(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)。与非结核性慢性难愈创面患者相比,结核性创面患者创面形成时间长,创面诊治困难,创面多分布于胸部且常伴有窦道形成,住院时间长,医疗费用高。此外,两组患者创面治疗费用主要由社会基本医疗保险和患者本人支付。

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