Epidemiological characteristics of adult inpatients with diabetes-related chronic non-healing wounds in Hainan province
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摘要:
目的 分析海南省糖尿病相关慢性难愈性创面成年住院患者的流行病学特征。 方法 该研究为回顾性队列研究。2019年7月—2024年7月,海南省3家医院收治1 372例符合入选标准的糖尿病相关慢性难愈性创面成年住院患者,其中海南医科大学第一附属医院收治951例、海南医科大学第二附属医院收治287例、海南省中德骨科医院收治134例。收集患者临床资料,包括年龄、性别、职业,糖尿病病程、分型,合并基础疾病,创面形成原因、类型、部位、数量,入院时创面分泌物标本病原微生物培养结果,创面治疗方式及出院时转归情况,以及不同类型创面患者的住院时间、住院费用。 结果 患者年龄18~96岁,其中≥60岁者892例；患者中男889例、女483例；农业从业者838例。患者糖尿病病程为10（5,18）年,98.91%（1 357/1 372）的患者为2型糖尿病患者。糖尿病患者常合并高血压（678例）、动脉性疾病（300例）和脑卒中（220例）等。创面形成原因以感染为主（930例）；创面类型以糖尿病足溃疡（DFU）为主（809例）,其次为其他创面（232例）、压力性损伤（187例）、创伤性溃疡（144例）；创面主要位于足部（809个）及小腿（474个）,且主要为1个创面（997例）。540例患者创面分泌物标本病原微生物培养结果为阳性,共检出病原微生物606株,以革兰阴性菌（324株）为主,主要病原微生物为金黄色葡萄球菌（125株）、铜绿假单胞菌（71株）和大肠埃希菌（71株）；真菌检出率较高,为6.11%（37/606）。创面治疗方式以单纯清创（396例）、清创+负压封闭引流（444例）为主。出院时,84.62%（1 161/1 372）的患者创面好转,11.30%（155/1 372）的患者创面愈合,3.28%（45/1 372）的患者创面加重,其余0.80%（11/1 372）的患者死亡。DFU患者住院时间[18（10,29）d]及住院费用[3.9（2.1,6.0）万元]均较压力性损伤患者[14（7,21）d、2.8（1.5,4.2）万元]、创伤性溃疡患者[12（6,18）d、2.3（1.2,3.5）万元]及其他创面患者[16（8,25）d、3.1（1.8,5.0）万元]显著增加（P<0.05）。 结论 海南省糖尿病相关慢性难愈性创面成年住院患者以老年男性农业从业者为主,通常合并基础疾病,创面检出病原微生物以革兰阴性菌为主,真菌检出率较高。DFU治疗负担最重,DFU患者住院时间及住院费用均较其他创面患者显著增加。 Abstract:Objective To analyze the epidemiological characteristics of adult inpatients with diabetes-related chronic non-healing wounds in Hainan province. Methods This study was a retrospective cohort study. From July 2019 to July 2024, 1 372 adult inpatients with diabetes-related chronic non-healing wounds and conformed to the inclusion criteria were admitted to three hospitals in Hainan province, including 951 cases in the First Affiliated Hospital of Hainan Medical University, 287 cases in the Second Affiliated Hospital of Hainan Medical University, and 134 cases in Hainan Sino-German Orthopedic Hospital. The clinical data of patients were collected, including age, gender, occupation, disease duration and type of diabetes mellitus, underlying comorbidity, formation cause, type, location, and number of wounds, pathogenic microorganism culture result of wound secretion specimens on admission, treatment modality and outcome at discharge, and hospitalization duration and hospitalization costs of patients with different types of wounds. Results The patients were 18-96 years in age, with 892 patients aged ≥60 years. There were 889 males and 483 females, with 838 agricultural workers. The duration of diabetes mellitus was 10 (5,18) years, and 98.91% (1 357/1 372) of the patients had type 2 diabetes mellitus. Patients with diabetes mellitus were often combined with hypertension (678 cases), arterial disease (300 cases), and stroke (220 cases). The primary cause of wound formation was infection (930 cases). The predominant type of wounds was diabetic foot ulcer (809 cases), followed by other wounds (232 cases), pressure ulcers (187 cases), and traumatic ulcers (144 cases). The wounds were primarily located on feet (809 wounds) and lower legs (474 wounds) with single wound (997 cases). The pathogenic microorganism culture results of wound secretion specimens from 540 patients were positive, with a total of 606 strains of pathogenic microorganism detected, predominantly Gram-negative bacteria (324 strains). The main pathogenic microorganisms were Staphylococcus aureus (125 strains), Pseudomonas aeruginosa (71 strains), and Escherichia coli (71 strains). Fungal detection rate was high of 6.11% (37/606). The primarily wound treatment modalities included simple debridement (396 cases) and debridement combined with vacuum sealing drainage (444 cases). At discharge, the wounds in 84.62% (1 161/1 372) of the patients showed improvement, 11.30% (155/1 372) of the patients achieved wound healing, and 3.28% (45/1 372) of the patients experienced wound exacerbation; the other 0.80% (11/1 372) of the patients died. Patients with diabetic foot ulcer exhibited significantly longer hospitalization duration (18 (10, 29) d) and higher hospitalization costs (3.9 (2.1, 6.0) ten thousand yuan) compared with patients with pressure ulcer (14 (7, 21) d and 2.8 (1.5, 4.2) ten thousand yuan), traumatic ulcer (12 (6, 18) d and 2.3 (1.2, 3.5) ten thousand yuan), and other wounds (16 (8, 25) d and 3.1 (1.8, 5.0) ten thousand yuan), P<0.05. Conclusions The adult inpatients with diabetes-related chronic non-healing wounds in Hainan province are predominantly elderly male agricultural workers with underlying comorbidities. The detected predominant pathogenic microorganisms in wounds are Gram-negative bacteria, and fungal detection rate is high. Diabetic foot ulcer poses greater treatment burden, and patients with diabetic foot ulcers had significantly longer hospitalization duration and higher hospitalization costs compared with those of other wounds. -
Key words:
- Diabetes mellitus /
- Epidemiology /
- Diabetic foot /
- Ulcer /
- Chronic wounds /
- Hainan province /
- Pathogenic microorganism
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参考文献
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Table 1. 1 372例糖尿病相关慢性难愈性创面成年住院患者的基本资料
基本资料与分类 例数 比例（%） 年龄（岁） 18~<45 81 5.90 45~59 399 29.08 ≥60 892 65.01 性别 男 889 64.80 女 483 35.20 职业 农业从业者 838 61.08 职员 240 17.49 自由职业者 180 13.12 无业人员 57 4.15 不详 57 4.15 不良生活习惯 仅吸烟 181 13.19 仅饮酒 138 10.06 吸烟+饮酒 94 6.85 无 959 69.90 
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Table 2. 1 372例糖尿病相关慢性难愈性创面成年住院患者合并基础疾病情况
基础疾病 例数 比例（%） 高血压 678 49.42 动脉性疾病 300 21.87 脑卒中 220 16.03 贫血 146 10.64 呼吸系统疾病 125 9.11 低蛋白血症 80 5.83 肾脏疾病 52 3.79 消化系统疾病 66 4.81 静脉性疾病 22 1.60
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Table 3. 1 372例糖尿病相关慢性难愈性创面成年住院患者的创面特征
创面特征与分类 例数/个数 比例（%） 创面形成原因 感染 930 67.78 压力性损伤 187 13.63 创伤 80 5.83 手术 64 4.66 瘢痕 61 4.45 其他 50 3.64 创面类型 糖尿病足溃疡 809 58.97 压力性损伤 187 13.63 创伤性溃疡 144 10.50 其他 232 16.91 创面部位 足部 809 45.09 小腿 474 26.42 躯干 252 14.05 上肢 133 7.41 头面颈部 34 1.90 大腿 34 1.90 骶尾部 26 1.45 臀部 21 1.17 会阴部 11 0.61 创面数量（个） 1 997 72.67 ≥2 375 27.33 注：其他创面形成原因包括肿瘤、静脉淤积等；其他创面类型包括术后切口愈合不良、瘢痕溃疡等；创面部位的单位为个数,其他指标的单位为例数；创面总数为1 794个
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Table 4. 1 372例糖尿病相关慢性难愈性创面成年住院患者的创面分泌物标本病原微生物培养结果
病原微生物与分类 株数 比例（%） 革兰阳性菌 金黄色葡萄球菌 125 20.63 粪肠球菌 50 8.25 无乳链球菌 21 3.47 棒状杆菌 15 2.48 停乳链球菌 10 1.65 血液链球菌 8 1.32 表皮葡萄球菌 3 0.50 革兰阴性菌 铜绿假单胞菌 71 11.72 大肠埃希菌 71 11.72 肺炎克雷伯菌 61 10.07 奇异变形杆菌 49 8.09 阴沟肠杆菌 19 3.14 摩氏摩根菌 14 2.31 鲍曼不动杆菌 10 1.65 粘质沙雷菌 10 1.65 普通变形杆菌 9 1.49 产气肠杆菌 8 1.32 嗜麦芽窄食单胞菌 2 0.33 真菌 37 6.11 其他 13 2.15 合计 606 100 注：其他病原微生物包括厌氧菌及采用常规方法未能鉴定到种的菌株等
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Table 5. 1 372例糖尿病相关慢性难愈性创面成年住院患者的创面治疗方式
创面治疗方式 例数 比例（%） 单纯清创 396 28.86 清创+VSD 444 32.36 清创+骨水泥 138 10.06 清创+VSD+皮片移植 86 6.27 清创+截肢或截趾术 85 6.20 清创+VSD+皮瓣移植 8 0.58 单纯换药 155 11.30 其他 60 4.37 注：VSD为负压封闭引流；其他创面治疗方式包括人工真皮移植、骨膜牵张等
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Table 6. 1 372例糖尿病相关慢性难愈性创面成年住院患者的住院时间及住院费用
住院时间和住院费用与分类 例数 比例（%） 住院时间（d） ≤7 291 21.21 8~14 399 29.08 15~21 268 19.53 ≥22 414 30.17 住院费用（万元） <2 713 51.97 2~<4 340 24.78 4~<6 174 12.68 ≥6 145 10.57
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Table 7. 不同类型糖尿病相关慢性难愈性创面成年住院患者的住院时间和住院费用及创面愈合情况比较
创面类型 例数 住院时间[d,M（Q1,Q3）] 住院费用[万元,M（Q1,Q3）] 好转+愈合率[例（%）] 糖尿病足溃疡 809 18（10,29） 3.9（2.1,6.0） 770（95.18） 压力性损伤 187 14（7,21）a 2.8（1.5,4.2）a 183（97.86） 创伤性溃疡 144 12（6,18）a 2.3（1.2,3.5）a 140（97.22） 其他 232 16（8,25）a 3.1（1.8,5.0）a 223（96.12） 统计量值 H=45.23 H=52.67 χ2=3.58 P值 <0.001 <0.001 0.310 注：其他创面类型包括术后切口愈合不良、瘢痕溃疡等；与糖尿病足溃疡比较,aP<0.05
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