总结慢性皮肤溃疡的临床特点并对影响治疗效果的因素进行分析，以提高临床诊疗水平。

采用回顾性分析，收集新疆医科大学第一附属医院2018年1月至2021年3月收治的符合入选标准的92例慢性皮肤溃疡住院患者临床资料。统计患者的一般资料如性别、年龄、是否患有基础疾病及其类型、溃疡类型、溃疡发生部位等情况；对患者创面分泌物进行细菌培养，分析创面检出病原菌情况；对创面检出病原菌进行药物敏感试验，分析病原菌对不同抗生素的敏感性；统计患者的治疗方式，计算不同治疗方式的治愈率；检测患者血液中白细胞计数、中性粒细胞计数和甘油三酯、胆固醇值，分析影响慢性皮肤溃疡患者病情转归的相关因素。数据比较采用χ²检验和logistic回归分析。

(1)92例慢性皮肤溃疡住院患者中，男46例(50%)，女46例(50%)；其中55~70岁患者最多，占30.43%，其次是40~54岁患者，占29.35%，年龄>70岁患者最少，占17.39%；92例患者中，67例伴有影响创面愈合的基础疾病，其中32例患者合并2种以上基础疾病。(2)92例慢性皮肤溃疡患者中，恶性溃疡最为常见，占22.8%，其次是血管性溃疡，占21.7%、感染性溃疡及术后不愈性溃疡均占15.2%，创伤性溃疡占9.8%，瘢痕溃疡、压力性溃疡、放射性溃疡占比较小，分别为6.5%、5.4%、3.3%。(3)92例患者中，最常见的溃疡部位是下肢，包括足踝部17例(18.5%)，小腿10例(10.9%)，大腿3例(3.3%)；第2、3位常见的溃疡部位分别为头面颈部、胸腹背部，占比分别为20.7%、19.6%，其余部位相对较少，占比均不足10.0%。(4)细菌培养共检出细菌80株，其中革兰氏阳性菌共54株(67.5%)，革兰氏阴性菌共26株(32.5%)，检出的革兰氏阳性菌以金黄色葡萄球菌(35.0%)、表皮葡萄球菌(13.8%)、屎肠球菌(7.5%)为主；革兰氏阴性菌以大肠埃希菌(7.5%)、铜绿假单胞菌(6.3%)为主。(5)根据药物敏感试验结果分析可得表皮葡萄球菌对红霉素耐药率100.0%，对青霉素、克林霉素耐药率均为90.9%；表皮葡萄球菌对利奈唑胺、万古霉素、利福平、替加环素敏感，敏感率分别为为100.0%、100.0%、63.6%、63.6%；金黄色葡萄球菌对青霉素耐药率96.4%、对红霉素耐药率82.1%；金黄色葡萄球菌对利奈唑胺、利福平、替加环素、万古霉素敏感，敏感率分别为89.3%、85.7%、85.7%、100.0%；屎肠球菌对万古霉素、替加环素敏感，敏感率分别为83.3%、83.3%；大肠埃希菌对头孢替坦、美洛培南、亚胺培南、哌拉西林、阿米卡星敏感，敏感率分别为100.0%、83.3%、83.3%、83.3%、83.3%。(6)92例患者采取了3种治疗方式，其中14例接受非手术治疗，78例接受手术治疗，接受手术治疗的患者中42例行手术联合负压封闭引流治疗，36例行单纯手术治疗；接受手术联合负压封闭引流治疗、单纯手术治疗、非手术治疗的患者治愈率分别为66.67%、38.89%、7.14%，3种治疗方式患者的治愈率比较，差异有统计学意义(χ²＝35.1，P<0.05)，且接受手术联合负压封闭引流治疗的患者治愈率分别与单纯手术治疗的患者和非手术治疗的患者治愈率比较，差异均有统计学意义(χ²＝6.0、28.5，P<0.05)。(7)对影响慢性皮肤溃疡患者病情转归的相关因素进行分析可得，手术联合负压封闭引流治疗、中性粒细胞计数是影响慢性皮肤溃疡患者疗效的独立影响因素。

对慢性皮肤溃疡来说，中老年人是其好发人群，恶性溃疡是其最常见的病因，小腿及足踝部是其最主要的发病部位，金黄色葡萄球菌是其最主要的感染细菌，手术联合负压封闭引流治疗的效果最佳，中性粒细胞计数正常的患者治疗效果最好。

To summarize the clinical characteristics of chronic skin ulcers and analyze the factors affecting the treatment effect, so as to improve the clinical diagnosis and treatment level.

A retrospective analysis was used to collect clinical data from 92 inpatients with chronic skin ulcers admitted to First Affiliated Hospital of Xinjiang Medical University from January 2018 to March 2021 who met the inclusion criteria. The general information of the patients were collected, such as gender, age, whether they have basic diseases and types, types of ulcers, and the location of ulcers, etc. Bacterial culture was carried out on the patient′s wound secretions to analyze the pathogenic bacteria detected on the wound surface; drug sensitivity tests were performed on the pathogenic bacteria detected on the wound surface to analyze the sensitivity of pathogenic bacteria to different antibiotics. Patients′ treatment modalities were counted, and the cure rates of different treatment modalities were calculated; the white blood cell count, neutrophil count, triglyceride and cholesterol values in patients′ blood were measured, and the relevant factors affecting the outcome of patients with chronic skin ulcers were analyzed. Data were compared by chi-square test and logistic regression analysis.

(1) Among the 92 inpatients with chronic skin ulcers, 46(50%) were male and 46 (50%) were female; the 55-70 years old patients were the most, accounting for 30.43%, followed by 40-54 years old, accounting for 29.35%, and the patients aged >70 years were the least, accounting for 17.39%; among the 92 patients, 67 patients had basic diseases that affected wound healing, and 32 of them had more than 2 basic diseases. (2) Among the 92 patients with chronic skin ulcers, malignant ulcers were the most common, accounting for 22.8%, followed by vascular ulcers, accounting for 21.7%, infectious ulcers and postoperative non-healing ulcers accounting for 15.2% respectively, and traumatic ulcers accounting for 9.8%; scar ulcers, pressure ulcers, and radiation ulcers accounted for smaller proportion, accounting for 6.5%, 5.4%, and 3.3%, respectively. (3)Among the 92 patients, the most common ulcer site was the lower extremity, including 17 cases (18.5%) of the ankle, 10 cases (10.9%) of the calf, and 3 cases (3.3%) of the thigh; the second and third sites for ulcers were the head, face and neck, chest, abdomen and back, accounting for 20.7% and 19.6%, with the remaining sites being relatively few, all accounting for less than 10.0%.(4) A total of 80 strains of pathogenic bacterial were detected, including 54 (67.5%) gram-positive bacteria and 26 (32.5%) gram-negative bacteria. The main detected gram-positive bacteria were Staphylococcus aureus (35.0%), Staphylococcus epidermidis (13.8%), and Enterococcus faecakis (7.5%); gram-negative bacteria were mainly Escherichia coli (7.5%) and Pseudomonas aeruginosa (6.3%). (5) According to the drug susceptibility test results, the resistance rate of Staphylococcus epidermidis to erythromycin was 100.0%, and the resistance rate to penicillin and clindamycin was 90.9%; Staphylococcus epidermidis was resistant to linezolid, vancomycin, rifampicin and tigecycline, and the sensitivity rates were 100.0%, 100.0%, 63.6%, and 63.6%; Staphylococcus aureus was 96.4% resistant to penicillin and 82.1% resistant to erythromycin; Staphylococcus aureus sensitive to linezolid, rifampicin, tigecycline, and vancomycin, the sensitivity rates were 89.3%, 85.7%, 85.7%, and 100.0%; Enterococcus faecium was sensitive to vancomycin, tigecycline, and the sensitivity rates were 83.3% and 83.3%, respectively; Escherichia coli was sensitive to cefotetan, meropenem, imipenem, piperacillin, and amikacin, and the sensitivity rates were 100.0%, 83.3%, 83.3%, 83.3%, and 83.3%. (6)Night-two patients were treated in three ways, 14 of them received non-surgical treatment and 78 received surgical treatment; among the patients who received surgical treatment, 42 were treated with surgical combined with negative pressure sealing drainage technique and 36 were treated with surgical treatment alone; the cure rates of patients who received surgical combined with negative pressure sealing drainage technique, surgical treatment alone and non-surgical treatment were 66.67%, 38.89% and 7.14%, respectively. There was a statistically significant difference in the cure rates of the three treatment methods (χ²=35.1, P<0.05), and the cure rate of patients receiving surgery combined with negative pressure sealing drainage technique was compared with that of patients treated with surgery alone and those treated without surgery, and the differences were statistically significant (χ²=6.0, 28.5; P<0.05). (7) Analysis of the factors affecting the outcome of patients with chronic skin ulcers showed that surgery combined with negative pressure sealing drainage technique and neutrophil count were independent factors affecting the outcome of patients with chronic skin ulcers.

For chronic skin ulcers, middle-aged and elderly people are the prone population, malignant ulcers are the most common cause, crus and ankle are the most important sites, Staphylococcus aureus is the most important bacterial infection, surgery combined with negative pressure sealing drainage technique has the best effect and better outcomes in patients with normal neutrophil counts.