392例慢性创面患者的病因与疗效分析

目的总结慢性创面临床特征与治疗经验。方法回顾性分析2000年1月～2010年12月重庆医科大学附属第一医院收治392例慢性创面患者的临床资料。结果慢性创面患者以创伤性（85例）、压疮（58例）、术后（50例）、糖尿病性（48例）、烧伤性（35例）、血管性（31例）等为主;占78.32%（307/392）。其中对237例行创面细菌培养,结果阳性205例,共培养出353株细菌,以金黄色葡萄球菌（52株）、大肠埃希菌（45株）、铜绿假单胞属（46株）、肺炎克雷伯（27株）等为主。对332例行手术治疗,皮片移植191例,皮瓣修复82例,皮片移植＋皮瓣修复19例,清创缝合40例。392例中365例治愈（49例行再手术）,25例因经济等原因未愈出院,2例压疮因并发症死亡。结论慢性创面主要受严重创伤、感染、血液和神经营养以及细胞功能障碍等因素影响,重视病因分析,加强创面床准备,选择最佳治疗方案,早期适时运用整形外科技术封闭创面,能显著促进创面愈合。

Clinical analysis of chronic wounds

Objective To sum up the clinical characteristics and experience in the treatment of chronic wounds.Methods A retrospective analysis of clinical characteristics and therapy in 392 patients were performed.Results There were main 85 traumatic ulcers,58 pressure ulcers,50 postoperative ulcers,48 diabetes ulcers,35 burn ulcers,31 Vascular ulcers in this grup.Bacterial cultures in 237 cases were taken,205 cases were positive,353 strains of pathogenic bacteria of positive cultures,The Mainly pathogens were Staphylococcus aureus（52）,Escherichia coli（45）,Pseudomonas aeruginosa（46）,Klebsiella pneumonia（27）;332 patients underwent operations,191 Skin grafting,82 skin flap,19 Skin grafting combining skin flap,40 debridement and suturing;365 patiens were recovery（49 patiens underwent re-operation）,25 patiens had to leave hospital because economic burden,2 patients with pressure ulcers died of complications.Conclusion Healing of chronic wounds was interfered with evere trauma、infection、sblood-nerve nutritional disorder and cell dysfunction,emphasizing on etiological analysis and wound bed preparation,selecting the optimal treatment regimen,appling the technology of Plastic surgery to treat chronic wounds in early stage,could significantly promote wound healing.