通过对湖北省某创面修复中心慢性难愈合创面住院患者的病例资料进行回顾，分析其流行病学特点，以期为该病防治对策的制订提供参考。

回顾性分析2018年1月至2019年12月华中科技大学同济医学院附属梨园医院创面修复中心收治的慢性难愈合创面住院患者的病例资料。收集信息包括患者的性别、居住地区、职业、基础疾病、吸烟史、创面类型、年龄、住院时间、住院费用、治疗方式(手术治疗、保守治疗)、临床转归、各项医疗费用情况及创面检出病原菌情况。数据比较采用χ²检验和Kruskal-Wallis H检验。

(1)本研究共纳入慢性难愈合创面住院患者2 402例，其中男1 593例(66.3%)，女809例(33.7 %)；城市人口1 459例(60.7%)，农村人口943例(39.3%)；患者离退休及从事体力劳动所占比例较大，分别为52.1%、28.8%；74.4%的患者合并有糖尿病，其次是高血压(57.5%)和心脏病(31.8%)；52.7%的患者有吸烟史。(2)不同创面类型中，糖尿病创面最为多见，占62.3%(1 497/2 402)；其次是压力性创面，占13.9%(334/2 402)；动脉性创面占6.2%(148/2 402)；静脉性创面占5.0%(121/2 402)，其他原因所致创面占12.6%(302/2 402)。(3)不同创面类型的慢性难愈合创面患者的性别和年龄段分布比较，差异均有统计学意义(χ²＝30.564、28.536，P<0.05)；其中患病比例最高的年龄段为61～80岁(54.7%)，其次为41～60岁(29.4%)和80岁以上(11.8%)；41～60岁和61～80岁为糖尿病创面和静脉性创面高发年龄段，61～80岁和80岁以上为压力性创面和动脉性创面高发年龄段。(4)2 402例慢性难愈合创面住院患者中，压力性创面患者的平均住院时间最长，为31(19, 35) d，动脉性创面和静脉性创面患者的平均住院时间最短，分别为19(9, 25)d和19(11, 26)d；动脉性创面患者的平均住院费用最高，为91 361.5(17 033.5, 143 090.4)元，其次为糖尿病创面患者，为45 008.4(10 574.0, 57 020.7)元；不同类型慢性难愈合创面住院患者的住院时间及住院费用比较，差异均有统计学意义(χ²＝25.346、32.460，P<0.05)。(5)手术治疗的患者中，压力性创面患者的住院时间最长，为39(26, 42) d、动脉性创面患者的住院费用最高，为118 341.1(77 151.3, 162 281.1)元；保守治疗的患者中，其他创面患者的住院时间最长、动脉性创面患者的住院费用最高；不同治疗方式患者的住院费用及住院时间比较，差异均有统计学意义(χ²＝110.260、120.765，P<0.05)。(6)2 402例患者中，痊愈占22.0%(529/2 402)，显效占76.3%(1 833/2 402)，未愈占1.7%(40/2 402)，未愈患者中死亡12例，占患者总人数的0.5%；痊愈、显效、未愈患者的住院时间分别为31(15, 39)、25(12, 30)、19(5, 24) d，住院费用分别为45 360.6(11 664.3, 56 208.8)、42 824.2(10 107.1, 52 415.1)、37 017.4(8 031.3, 31 942.9)元，痊愈患者的住院时间比显效及未愈患者长，其住院费用比显效及未愈患者多，不同临床转归患者住院时间和住院费用比较，差异均无统计学意义(χ²＝3.031、6.780，P>0.05)。(7)2 402例慢性难愈合创面住院患者的总医疗费用为103 973 107元，各项医疗费用中耗材费和药品费占比较高，分别为42.1%和23.4%，护理费和输血费用占比较低，分别为1.2%和0.2%。(8)2 402例患者中有926例(38.6%)进行了创面病原菌检查，其中681例创面病原菌检测结果为阳性，检测阳性率为73.5%(681/926)。其中革兰阴性菌占50.8%(346/681)，主要以铜绿假单胞菌(13.5%)、大肠杆菌(11.6%)、鲍曼不动杆菌(6.2%)为主；革兰阳性菌占42.4%(289/681)，主要以金黄色葡萄球菌(17.8%)、表皮葡萄球菌(7.2%)、肠球菌属(9.2%)为主；真菌占6.8%(46/681)，主要为白色念珠菌(2.5%)。

慢性难愈合创面住院患者以中老年人为主，男性多于女性。糖尿病创面、压力性创面及血管性创面是该病主要原因。压力性创面的患者平均住院时间最长，动脉性创面患者的平均住院费用最高。治疗方式以手术为主，本中心采用多学科诊疗模式进行创面治疗，愈合率较高。创面病原菌中以革兰阴性菌最为多见，以铜绿假单胞菌、大肠杆菌、鲍曼不动杆菌为主。倡导健全大型综合医院创面治疗中心和社区卫生服务中心双向转诊机制，成立创面修复护理中心，同时加强对该病知识宣教，提高防治意识。

Analyzed the epidemiological characteristics of inpatients with chronic refractory wounds in a wound repair center in Hubei province by reviewing the data of them, in order to provide reference for the formulation of prevention and treatment strategies for the disease.

The case data of inpatients with chronic refractory wounds admitted to the Wound Repair Center of Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019 were retrospectively analyzed. The collected information includes the patient's gender, living area, occupation, underlying disease, smoking history, wound type, age, hospital stay, hospitalization cost, treatment method (surgical treatment, conservative treatment), clinical outcome, various medical expenses and wound surface detection of pathogenic bacteria. Data were compared by chi-square test and Kruskal-Wallis H test.

(1) A total of 2 402 inpatients with chronic refractory wounds were included in this study, including 1 593 males (66.3%) and 809 females (33.7%); there were 1 459 (60.7%) of the urban population and 943 cases (39.3%) of the rural population; the proportion of patients engaged in retirement and manual labor was relatively large, 52.1% and 28.8%, respectively; 74.4% of the patients had diabetes, followed by hypertension (57.5%) and heart disease (31.8%); 52.7% of patients had a history of smoking. (2) Among different wound types, diabetic wounds were the most common, accounting for 62.3% (1 497/2 402); followed by pressure wounds, accounting for 13.9% (334/2 402); arterial wounds accounted for 6.2% (148/2 402); venous wounds accounted for 5.0% (121/2 402), and wounds caused by other reasons accounted for 12.6% (302/2 402). (3) The gender and age distribution of chronic refractory wound patients with different types of wounds were compared, and the differences were statistically significant (χ²=30.564, 28.536; P<0.05); the age group with the highest prevalence rate was 61-80 years old (54.7%), followed by 41-60 years old (29.4%) and over 80 years old (11.8%); 41-60 years old and 61-80 years old with high incidence of diabetic wounds and venous wounds, and 61-80 years old and over 80 years old were the high incidence of pressure wounds and arterial wounds. (4) Among the 2 402 inpatients with chronic refractory wounds, the patients with pressure wounds had the longestaverage hospital stay, which was 31 (19, 35) d, and the patients with arterial wounds and venous wounds had the shortest average hospitalization time, which were 19 (9, 25) d and 19 (11, 26) d, respectively. The average hospitalization cost of patients with arterial wounds was the highest, which was 91 361.5 (17 033.5, 143 090.4) yuan, followed by patients with diabetic wounds, which was 45 008.4 (10 574.0, 57 020.7) yuan. There were statistically significant differences in hospitalization time and hospitalization expenses among patients with different types of chronic refractory wounds (χ²=25.346, 32.460; P<0.05). (5) Among the patients treated by surgery, patients with pressure wounds had the longest hospitalization time 39 (26, 42) d, and patients with arterial wounds had the highest hospitalization costs, which was 118 341.1 (77 151.3, 162 281.1) yuan; among the patients with conservative treatment, other wound patients had the longest hospitalization time, and patients with arterial wounds had the highest hospitalization costs; the hospitalization costs and hospitalization time of patients with different treatment methods were statistically significantly differents (χ²=110.260, 120.765; P<0.05). (6) Among the 2 402 patients, 22.0% (529/2 402) were cured, 76.3% (1 833/2 402) were markedly effective, 1.7% (40/2 402) were not cured, and 12 of them died, accounting for 0.5% of the total number of patients. The hospitalization time of the cured, markedly effective and unhealed patients were 31 (15, 39), 25 (12, 30), and 19 (5, 24) d, respectively, and the hospitalization expenses were 45 360.6 (11 664.3, 56 208.8), 42 824.2 (10 107.1, 52 415.1), 37 017.4 (8 031.3, 31 942.9) yuan, respectively. The hospitalization time of cured patients was longer than that of markedly effective and unhealed patients, and the hospitalization cost was higher than that of markedly effective and unrecovered patients. There were no statistically significant differences in hospitalization time and hospitalization cost among patients with different clinical outcomes (χ²=3.031, 6.780; P>0.05). (7) The total medical expenses of the 2 402 inpatients with chronic refractory wounds were 103 973 107 yuan. Consumables and medicines accounted for a relatively high proportion of various medical expenses, accounting for 42.1% and 23.4%, respectively. Nursing expenses and blood transfusion expenses accounted for a relatively low proportion, at 1.2% and 0.2%, respectively. (8) Among the 2 402 patients, 926 (38.6%) were examined for pathogenic bacteria on the wound surface, of which 681 were positive for pathogenic wounds, with a positive rate of 73.5% (681/926). Among them, Gram-negative bacteria accounted for 50.8% (346/681), mainly Pseudomonas aeruginosa (13.5%), Escherichia coli (11.6%), and Acinetobacter baumannii (6.2%); Gram-positive bacteria accounted for 42.4% (289/681), mainly Staphylococcus aureus (17.8%), Staphylococcus epidermidis (7.2%), and Enterococcus (9.2%); fungi accounted for 6.8% (46/681), mainly Candida albicans (2.5%).

The inpatients with chronic refractory wounds are mainly middle-aged and elderly people, and there are more males than females. Diabetic wounds, pressure wounds and vascular wounds are the main causes of the disease. Patients with pressure wounds had the longest average hospital stay, and patients with arterial wounds had the highest average hospitalization costs. The main treatment method is surgery. The unit adopts a multidisciplinary diagnosis and treatment mode for wound treatment, and the healing rate is high. Gram-negative bacteria are the most common pathogens on the wound surface, mainly Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. It is necessary to advocate and improve the two-way referral mechanism between wound treatment centers in large general hospitals and community health service centers, and establish wound repair and nursing centers, strengthen publicity and education about the disease, and improve awareness of prevention and treatment.