| 陈秀芳,何仁亮,朱定衡,任俊男,刘柳宏.65例慢性皮肤溃疡患者临床特征分析[J].中国烧伤创疡杂志,2024,(3):179~182. |
| DOI： |
| 中文关键词: 皮肤溃疡 慢性皮肤溃疡 病理特征 临床特征 |
| 英文关键词:Skin ulcer Chronic skin ulcer Pathological features Clinical features |
| 基金项目:中国红十字基金会徐荣祥再生生命公益基金 (RXRL2021-01) |
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| 中文摘要: |
| 【摘要】 目的 回顾性分析 65 例慢性皮肤溃疡患者的临床特征。方法 选取 2019 年 9 月至 2021 年 8 月南方医科大学皮肤病医院收治的 65 例慢性皮肤溃疡患者作为研究对象, 收集并统计患者性别、年龄、病程、发病部位、致伤原因、创面面积、血常规指标、创面病原菌感染及分布特点、创面组织病理特征、治疗方法与转归等资料, 分析临床特征。结果 65 例患者中男性 35 例、女性 30 例; 年龄 10 ~ 88 岁, 以 50 岁以上患者占比最高,达 67.69% (44 / 65); 病程 28~ 7 300 d, 中位病程 150 d; 单发溃疡 56 例 (86.15%)、多发溃疡 9 例 (13.85%),且累及下肢者占比最高, 达 64.62% (42 / 65); 可明确致伤原因者 45 例 (69.23%), 以下肢静脉曲张最为多见;创面面积 0.5 cm×0.5 cm~ 30.0 cm×40.0 cm。65 例患者中白细胞计数高于正常值 9 例 (13.85%)、低于正常值 2例 (3.08%), 中性粒细胞百分比高于正常值 5 例 (7.69%)、低于正常值 2 例 (3.08%)。65 例患者中 61 例进行了创面分泌物细菌培养、54 例进行了创面分泌物真菌培养、49 例进行了皮肤组织液分枝杆菌培养, 48 例分离出病原菌 55 株, 其中革兰氏阳性菌 18 株 (32.73%), 尤以金黄色葡萄球菌检出率 (20.00%) 最高; 革兰氏阴性菌 25 株 (45.45%), 尤以肺炎克雷伯杆菌及铜绿假单胞菌检出率 (均为 12.72%) 最高; 真菌 12 株 (21.82%), 尤以白色念珠菌检出率 (14.54%) 最高。65 例患者中 60 例进行了溃疡创面组织病理学检查, 检查结果为良性溃疡 56 例(93.33%)、癌性溃疡 4 例 (6.67%)。65 例患者中 64 例进行了创面治疗, 其中涉及手术治疗者 53 例 (82.81%), 且 64例进行创面治疗的患者中 62 例 (96.88%) 好转。结论 慢性皮肤溃疡以 50 岁以上男性居多, 病变部位以下肢为主,多合并或继发感染, 且病原菌尤以肺炎克雷伯杆菌及铜绿假单胞菌等革兰氏阴性菌占比最高, 组织病理学多表现为慢性炎性改变, 在清创的基础上联合应用负压封闭引流、皮片/ 皮瓣移植、富血小板血浆等进行治疗效果较好。 |
| 英文摘要: |
| 【Abstract】 Objective To retrospectively analyze the clinical features of 65 patients with chronic skin ulcer. Methods 65 patients with chronic skin ulcer admitted to Dermatology Hospital of Southern Medical University from September 2019 to August 2021 were selected as research subjects, and data of the patients were collected for the clinicalfeature analysis, including sex, age, disease duration, diseased region, causes of injury, the wound area, blood routine indicators, pathogenic bacteria infection and distribution characteristics of wounds, pathological features of wound tissues, treatment methods and prognosis. Results Among the 65 patients, there were 35 males and 30 females. The age ranged from 10 to 88 years old, with the highest proportion of patients over 50 years old accounting for 67.69% ( 44 / 65). The duration of disease ranged from 28 to 7,300 days, with the median duration of 150 days. There were 56 cases with single ulcer (86.15%) and 9 cases with multiple ulcers (13.85%), and the lower extremity is the mostly involved body parts, reaching 64.62% (42 / 65). The causes of injury could be identified in 45 cases (69.23%), and the lower limb varicose veins are the main cause. The wound area ranged from 0.5 cm×0.5 cm to 30.0 cm×40.0 cm. Among the 65 patients, 9 cases (13.85%) had the white blood cell count being higher than the normal level and 2 cases (3.08%) had a lower level, and 5 cases (7.69%) had a higher percentage of neutrophils than the normal value and 2 cases ( 3.08%) had a lower value. Among the 65 patients, 61 patients underwent bacterial culture of wound secretion, 54 patients underwent fungal culture of wound secretion, and 49 patients underwent mycobacterial culture of skin tissue fluid. 55 strains of pathogenic bacteria were isolated from 48 patients, among which 18 (32.73%) strains were gram-positive bacteria, with the highest detection rate in staphylococcus aureus (20.00%), 25 strains (45.45%) were gram-negative bacteria, with the highest detection rate in klebsiella pneumoniae and pseudomonas aeruginosa ( both 12.72%), and 12 strains ( 21.82%) were fungi, with the highest detection rate in candida albicans ( 14.54%). Among the 65 patients, 60 patients received histopathological examination on ulcer wounds, and the results showed 56 cases (93.33%) with benign ulcer and 4 cases ( 6.67%) with cancerous ulcer. Among the 65 patients, 64 patients received wound treatment, of which 53 cases (82.81%) underwent surgical treatment, and 62 cases (96.88%) realized improved wound condition. Conclusion Most of the patients with chronic skin ulcer were males over 50 years old, dominantly with lower extremity affected. Majority cases were complicated with infection or secondary infection, the gram-negative bacteria such as klebsiella pneumoniae and pseud-omonas aeruginosa account for the highest proportion, and the main manifestations of histopathology were chronic inflamma-tory changes. It is advised to manage such wounds with vacuum sealing drainage, skin grafts/ flap transplantation, and platelet-rich plasma after debridement for better clinical efficacy. |
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