Epidemiological investigation on clinical characteristics of 801 inpatients with chronic wounds
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摘要: 目的 分析801例住院慢性创面患者的临床特点。 方法 回顾性分析解放军南部战区总医院(下称笔者单位)2013年1月—2017年12月收治的符合入选标准的慢性创面患者的病历资料,包括性别、职业、创面类型、年龄、科室分布、痊愈情况、痊愈时间、住院时间、住院费用、治疗方式、临床转归、各项医疗费用情况。对数据行
χ 2检验、Fisher确切概率法检验及Kruskal-WallisH 检验。 结果 笔者单位5年间共收治245 037例住院患者,其中801例(3.3‰)为符合入选标准的慢性创面患者,5年间慢性创面患者构成比为2.4‰(106/44 230)~3.9‰(191/49 342)。患者中男527例、女274例;体力劳动、离退休及无业人员所占比例较大。慢性创面的最主要类型是手术后未愈创面,占28.2%(226/801);其次为糖尿病性创面,占22.7%(182/801);再次为创伤性创面,占16.5%(132/801)。不同类型慢性创面患者的性别分布比较,差异有统计学意义(χ 2=28.236,P <0.05)。男性患者以手术后未愈创面、糖尿病性创面及创伤性创面为主,女性患者以糖尿病性创面及手术后未愈创面为主。不同类型慢性创面患者的年龄段分布比较,差异有统计学意义(P <0.01)。41~60岁为手术后未愈创面和创伤性创面高发年龄段,61~80岁为糖尿病性创面高发年龄段。骨科收治患者痊愈率最高,其次是综合科。不同科室收治患者的住院时间及住院费用比较,差异有统计学意义(χ 2=47.390、107.390,P <0.05)。不同科室收治患者的痊愈情况与痊愈时间比较,差异无统计学意义(χ 2=7.163、15.510,P >0.05)。手术+药物治疗患者痊愈率较其他治疗方式高。不同治疗方式患者痊愈率比较,差异无统计学意义(χ 2=7.600,P >0.05)。不同治疗方式患者的痊愈时间、住院费用及住院时间比较,差异有统计学意义(χ 2=38.067、130.520、130.890,P <0.05)。不同临床转归情况患者住院费用及住院时间比较,差异无统计学意义(χ 2=2.070、5.790,P >0.05)。801例慢性创面患者的总医疗费用大约为4 700万元,其中住院费用最少为1 164元,最多约为116万元,人均住院总费用为50 725元。药品费和材料费占比较高。 结论 笔者单位收治慢性创面患者中以体力劳动、中老年人群为主,男性多于女性,手术后未愈创面是主要类型,给患者及社会带来严重的经济负担,需加强慢性创面知识宣传,提高防治意识。Abstract: Objective To analyze the clinical characteristics of 801 inpatients with chronic wounds. Methods The medical records of patients with chronic wounds who were admitted to the General Hospital of Southern Theater Command of PLA (hereinafter referred to as the author′s unit) from January 2013 to December 2017, including gender, occupation, wound type, age, department distribution, recovery status, recovery time, hospitalization time, hospitalization cost, treatment method, clinical outcome, and medical expenses were retrospectively analyzed. Data were statistically analyzed with chi-square test, Fisher′s exact probability test, and Kruskal-WallisH test. Results Of 245 037 inpatients admitted to the author′s unit within 5 years, 801 (3.3‰) patients with chronic wounds met the inclusion criteria. The composition ratio of chronic wound patients during the 5 years was 2.4‰ (106/44 230)-3.9‰ (191/49 342). Among chronic wound patients, there were 527 males and 274 females, with manual labor, retired, and unemployed patients accounted for a large proportion. The main type of chronic wound was unhealed wound after surgery, accounting for 28.2% (226/801), followed by diabetic wound, accounting for 22.7% (182/801) and traumatic wound, accounting for 16.5% (132/801). There was statistically significant difference in gender distribution of patients with different types of chronic wounds (χ 2=28.236,P <0.05). The main types of wound in male patients were unhealed wound after surgery, diabetic wound, and traumatic wound, while the main types of wound in female patients were diabetic wound and unhealed wound after surgery. There was statistically significant difference in the age group distribution of patients with different types of chronic wounds (P <0.01). Patients aged 41-60 years had a high incidence of unhealed wound after surgery and traumatic wound, and patients aged 61-80 years had a high incidence of diabetic wound. Patients with chronic wounds in department of orthopedics had the highest recovery rate, followed by comprehensive department. There were statistically significant differences in hospitalization time and hospitalization cost of patients with chronic wounds admitted to different departments (χ 2=47.390, 107.390,P <0.05). There were no statistically significant differences in cure status and cure time of patients with chronic wounds admitted to different departments (χ 2=7.163, 15.510,P >0.05). Patients treated with surgery in combination with drug had higher recovery rates than patients given other treatment methods. There was no statistically significant difference in the cure rate of patients with different treatment methods (χ 2=7.600,P >0.05). There were statistically significant differences in cure time, hospitalization cost, and hospitalization time of patients given different treatment methods (χ 2=38.067, 130.520, 130.890,P <0.05). There were no statistically significant differences in hospitalization cost and hospitalization time of patients with different clinical outcomes (χ 2=2.070, 5.790,P >0.05). The total medical cost of 801 patients with chronic wounds was about 47 million yuan, of which the total hospitalization cost per capita was 50, 725 yuan, with a minimum of 1 164 yuan and a maximum of about 1.16 million yuan per capita, and with drug and materials costs accounted for high proportions of the total cost. Conclusions Patients with chronic wounds in the author′s unit are mainly physical labor and middle-aged and elderly people, with more male patients than female patients. The main type of wound is unhealed wound after surgery, which brings serious economic burden to the patients and the society. Therefore, it is necessary to strengthen the public knowledge about chronic wounds and improve the awareness of prevention and treatment.-
Key words:
- Chronic disease /
- Inpatients /
- Epidemiology
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