65例慢性皮肤溃疡患者临床特征分析  

Analysis of Clinical Features of 65 Patients with Chronic Skin Ulcer

作　　者：陈秀芳 何仁亮 朱定衡 任俊男 刘柳宏 CHEN Xiufang;HE Renliang;ZHU Dingheng;REN Junnan;LIU Liuhong(Department of Wound Repair,The Second Affiliated Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410005,China;Department of Dermatologic Surgery,Dermatology Hospital of Southern Medical University,Guangzhou,Guangdong 510091,China)

机构地区：[1]长沙市中心医院皮肤科,湖南长沙410007 [2]南方医科大学皮肤病医院皮肤外科,广东广州510091

出　　处：《中国烧伤创疡杂志》2024年第3期179-182,共4页The Chinese Journal of Burns Wounds & Surface Ulcers

基　　金：中国红十字基金会徐荣祥再生生命公益基金(RXRL2021⁃01)。

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6769%(44/65);病程28~7300 d,中位病程150 d;单发溃疡56例(8615%)、多发溃疡9例(1385%),且累及下肢者占比最高,达6462%(42/65);可明确致伤原因者45例(6923%),以下肢静脉曲张最为多见;创面面积05 cm×05 cm~300 cm×400 cm。65例患者中白细胞计数高于正常值9例(1385%)、低于正常值2例(308%),中性粒细胞百分比高于正常值5例(769%)、低于正常值2例(308%)。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(3273%),尤以金黄色葡萄球菌检出率(2000%)最高;革兰氏阴性菌25株(4545%),尤以肺炎克雷伯杆菌及铜绿假单胞菌检出率(均为1272%)最高;真菌12株(2182%),尤以白色念珠菌检出率(1454%)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(9333%)、癌性溃疡4例(667%)。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(8281%),且64例进行创面治疗的患者中62例(9688%)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。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 clinical feature 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 6769%(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(8615%)and 9 cases with multiple ulcers(1385%),and the lower extremity is the mostly involved body parts,reaching 6462%(42/65).The causes of injury could be identified in 45 cases(6923%),and the lower limb varicose veins are the main cause.The wound area ranged from 05 cm×05 cm to 300 cm×400 cm.Among the 65 patients,9 cases(1385%)had the white blood cell count being higher than the normal level and 2 cases(308%)had a lower level,and 5 cases(769%)had a higher percentage of neutrophils than the normal value and 2 cases(308%)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(3273%)strains were gram-positive bacteria,with the highest detection rate in staphylococcus aureus(2000%),25 strains(4545%)were gram-negative bacteria,with the highest detection rate in klebsiella pneumoniae and pseudomonas aeruginosa(both 1272%),and 12 strains(2182%)were fungi,with the highest

关 键 词：皮肤溃疡 慢性皮肤溃疡 病理特征 临床特征 

分 类 号：R632.1[医药卫生—外科学]