Yang Y, Chu W L, Feng G, Zhang H J, Hao D F
Wound Repair Center of Department of Burns and Plastic Surgery, the Fourth Medical Center of PLA General Hospital, Beijing 100048, China.
Zhonghua Shao Shang Za Zhi. 2020 Sep 20;36(9):821-829. doi: 10.3760/cma.j.cn501120-20200202-00036.
To analyze the epidemiological characteristics and the related information on the diagnosis and treatment of inpatients with skin and soft tissue injuries. The medical records of inpatients with skin and soft tissue injuries who were admitted to the Fourth Medical Center of PLA General Hospital (hereinafter referred to as the author's unit) from January 1, 2014 to December 31, 2018, conforming to the study criteria, were retrospectively analyzed. The indexes included inpatients'gender, age, wound course, underlying disease, wound type, wound site, and wound microbiological culture result, methods and outcome of treatment, type of medical payment, hospital day, and hospitalization cost. Data were statistically analyzed with Mann-Whitney test, Kruskal-Wallis test, and chi-square test. (1) A total of 2 997 inpatients, conforming to the study criteria, were admitted to the author's unit during the 5 years. There were 1 803 (60.16%) males and 1 194 (39.84%) females. The distribution of gender of patients showed significant differences during the 5 years ((2)=13.203, <0.05). The age of female patients was significantly older than that of male patients (=-6.387, <0.01). There were 882 (29.43%) patients with acute wounds and 2 115 (70.57%) patients with chronic wounds. The distribution of acute wounds and chronic wounds of patients showed significant differences during the 5 years ((2)=66.806, <0.01). The age of patients with chronic wounds was significantly older than that of patients with acute wounds (=-12.582, <0.01). A total of 1 910 patients (3 847 cases) were complicated with underlying diseases. The common underlying diseases orderly were diabetes 1 151 (29.92%) cases, hypertension 884 (22.98%) cases, coro-nary atherosclerotic heart disease 414 (10.76%) cases, old cerebral infarction 258 (6.71%) cases, and paraplegia 258 (6.71%) cases. More patients with chronic wounds were complicated with various underlying diseases compared with patients with acute wounds ((2)=130.649, <0.01). (2) The common types of wounds were postoperative non-healing wounds, burn wounds, diabetic foot ulcers, pressure ulcers, and skin and soft tissue infection. The distribution of types of wounds showed significant differences during the 5 years ((2)=342.265, <0.01). There were 3 957 wounds. The common wound sites were feet, legs, chests, and so on. A total of 976 patients underwent microbiological examination. The results of 719 (73.67%) patients were positive and 257 (26.33%) patients were negative. The positive rate of wound microbiological culture of patients with chronic wounds was significantly higher than that of patients with acute wounds ((2)=33.981, <0.01). Among the patients with acute wounds, 111 patients (72.08%) were simply infected, 43 (27.92%) patients were mixed infected. Among the patients with chronic wounds, 364 (64.42%) patients were simply infected, and 201 (35.58%) patients were mixed infected. A total of 1 010 strains of pathogenic bacteria were detected in 719 patients, including 447 (44.26%) Gram-positive bacteria, 548 (54.26%) Gram-negative bacteria, and 15 (1.48%) fungi. There was a significant difference in the distribution of pathogenic microorganisms between patients with acute wounds and chronic wounds ((2)=12.215, <0.01). In this group of patients, the common strains of wounds were and so on. The common strains of patients with acute wounds were and so on. The common strains of patients with chronic wounds were and so on. (3) The patients in this group were mainly treated by surgery. Finally, 1 330 patients were cured, 1 393 patients were improved, 257 patients were not cured, and 17 patients died. There was a significant difference in the distribution of outcome in patients with acute wounds and chronic wounds (=-7.622, <0.01). (4) The main types of payment of medical expenses for patients in this group were local medical insurance, remote medical insurance, and self-paying. The total hospitalization cost of patients in this group was 169 268 523.65 yuan, which was mainly consist of the costs of materials and drugs. The hospital day of patients in this group was 21.00 (11.00, 36.00) d, and the hospitalization cost was 30 016.34 (14 439.41, 63 685.60) yuan. There were significant differences in the hospital day and hospitalization cost among patients with different medical payment types ((2)=285.986, 327.436, <0.01). There were significant differences in the hospital day and hospitalization cost among patients with different wound types ((2)=125.912, 131.485, <0.01). The patients with skin and soft tissue injuries are mainly middle-aged and elderly patients, with more males than females, more chronic wounds than acute wounds. Skin and soft tissue injuries are prone to occur in sites with prominent bone, thin subcutaneous fat, and poor blood supply. The result of wound microbiological culture is mainly Gram-negative bacteria, and the positive rate of wound microbiological culture of patients with chronic wounds is higher than that of patients with acute wounds. The proportion of Gram-positive bacterial infection ranks the highest in patients with acute wounds. The proportion of Gram-negative bacterial infection ranks the highest in patients with chronic wounds. Patients with chronic wounds are often complicated with various underlying diseases, and the course of disease is long, so the constituent ratio of cured patients is lower than that of patients with acute wounds. Patients with skin and soft tissue injuries have long hospital days and high proportion of material cost, which are directly related to the clinical characteristics and long treatment cycle of chronic wounds. Therefore, it is suggested that the medical insurance administration department should adjust the consumption ratio and other management indicators according to the actual clinical needs of elderly patients with chronic wounds.
分析皮肤和软组织损伤住院患者的流行病学特征及诊疗相关信息。回顾性分析2014年1月1日至2018年12月31日解放军总医院第四医学中心（以下简称作者单位）收治的符合研究标准的皮肤和软组织损伤住院患者的病历资料。观察指标包括患者的性别、年龄、伤口病程、基础疾病、伤口类型、伤口部位、伤口微生物培养结果、治疗方法及转归、医疗付费类型、住院天数及住院费用。采用Mann-Whitney检验、Kruskal-Wallis检验和卡方检验进行统计学分析。（1）5年间作者单位共收治符合研究标准的住院患者2 997例，其中男性1 803例（60.16%），女性1 194例（39.84%）。5年间患者性别分布差异有统计学意义（χ² =13.203，P<0.05）。女性患者年龄显著大于男性患者（Z=-6.387，P<0.01）。急性伤口患者882例（29.43%），慢性伤口患者2 115例（70.57%）。5年间急性伤口和慢性伤口患者分布差异有统计学意义（χ² =66.806，P<0.01）。慢性伤口患者年龄显著大于急性伤口患者（Z=-12.582，P<0.01）。共1 910例患者（3 847例次）合并基础疾病，常见基础疾病依次为糖尿病1 151例（29.92%）、高血压884例（22.98%）、冠状动脉粥样硬化性心脏病414例（10.76%）、陈旧性脑梗死258例（6.71%）、截瘫258例（6.71%）。慢性伤口患者合并各种基础疾病的比例高于急性伤口患者（χ² =130.649，P<0.01）。（2）常见伤口类型为术后不愈合伤口、烧伤创面、糖尿病足溃疡、压疮及皮肤软组织感染。5年间伤口类型分布差异有统计学意义（χ² =342.265，P<0.01）。共3 957处伤口，常见伤口部位为足部、腿部、胸部等。976例患者进行了微生物学检查，719例（73.67%）结果阳性，257例（26.33%）结果阴性。慢性伤口患者伤口微生物培养阳性率显著高于急性伤口患者（χ² =33.981，P<0.01）。急性伤口患者中，单纯感染111例（72.08%），混合感染43例（27.92%）。慢性伤口患者中，单纯感染364例（64.42%），混合感染201例（35.58%）。719例患者共检出病原菌1 010株，其中革兰阳性菌447株（44.26%），革兰阴性菌548株（54.26%），真菌15株（1.48%）。急性伤口和慢性伤口患者病原菌分布差异有统计学意义（χ² =12.215，P<0.01）。该组患者伤口常见菌株等。急性伤口患者常见菌株等。慢性伤口患者常见菌株等。（3）该组患者主要采用手术治疗。最终，治愈1 330例，好转1 393例，未愈257例，死亡17例。急性伤口和慢性伤口患者转归分布差异有统计学意义（Z=-7.622，P<0.01）。（4）该组患者医疗费用支付主要类型为当地医保、异地医保和自费。该组患者住院总费用为169 268 523.65元，主要由材料和药品费用构成。该组患者住院天数为21.00（11.00，36.00）d，住院费用为30 016.34（14 439.41，63 685.60）元。不同医疗付费类型患者住院天数和住院费用差异有统计学意义（χ² =285.986，327.436，P<0.01）。不同伤口类型患者住院天数和住院费用差异有统计学意义（χ² =125.912，131.485，P<0.01）。皮肤和软组织损伤患者以中老年为主，男性多于女性，慢性伤口多于急性伤口。皮肤和软组织损伤易发生于骨突出、皮下脂肪薄、血供差的部位。伤口微生物培养结果以革兰阴性菌为主，慢性伤口患者伤口微生物培养阳性率高于急性伤口患者。急性伤口患者革兰阳性菌感染比例最高。慢性伤口患者革兰阴性菌感染比例最高。慢性伤口患者常合并各种基础疾病，病程长，治愈患者构成比低于急性伤口患者。皮肤和软组织损伤患者住院时间长，材料费用占比高，这与慢性伤口的临床特点及治疗周期长直接相关。因此，建议医保管理部门根据老年慢性伤口患者实际临床需求调整报销比例等管理指标。
