四平市某医院2012-2014年度手外伤住院病例分析

发布时间：2018-04-29 23:42

本文选题：手外伤 + 住院病例　；参考：《吉林大学》2015年硕士论文

【摘要】：目的:手在人类的生产和生活中起着举足轻重的作用。随着机械化水平的提高和工业化的进展,手外伤的发生率有增无减。目前,我国手外伤的研究多集中在经济发达、工业化水平高的地区,由于地区、人群存在差异,手外伤的构成和分布也存在较大差异。查阅相关资料,关于东北地区手外伤研究相对较少,尚无关于四平地区手外伤研究的相关报道。本次研究旨在通过系统的收集和整理吉林省四平市某医院收治的2012年1月-2014年12月1100例手外伤住院患者的病例资料,以期了解四平地区手外伤发生特点及规律,为合理配置医疗资源、减少手外伤的发生提供依据。方法:所有病例来源于四平市某医院2012年1月-2014年12月期间的手外伤住院患者,共1100例。采用回顾性的研究方法,根据研究内容,设计统计表,从医院电子病历系统中提取相关信息。其内容主要包括:⑴患者基本信息:姓名、性别、年龄、职业、婚姻状况、文化程度、入院年份、入院月份、入院日期、出院日期、住院天数、住院费用、医疗付款方式。⑵患者疾病信息:损伤时段、损伤到就诊时间、损伤侧别、损伤部位、损伤组织、是否为多部位、损伤类型、损伤原因。⑶疾病治疗信息:麻醉方式、手术方式。结果:(1)1100例手外伤住院患者中,男性患者862例,占78.36%,女性238例,占21.64%。男性患者与女性患者的比例为3.62:1。(2)年龄最小者仅为1岁,年龄最大者89岁,平均年龄为38岁,其中发生手部损伤人数最多的年龄组为38-47岁,为298例,占27.09%;其次是48-57岁年龄组,214例占19.45%;第三位是28-37岁年龄组,204例占18.55%;58岁及以上者102例占9.27%;而18岁年龄组的人群发生手外伤的例数最少,为93例,仅占8.45%。(3)农民发生手外伤人数最多,587例,占53.36%,其次为工人,304例,占27.64%,而干部发生手外伤的例数最少,为57例,占总患者的5.18%。(4)初中文化程度患者所占比例最高,为52.18%;小学及以下文化程度占26.18%;大学及以上所占比例最低,为6.09%。(5)本次研究收集的1100例手外伤患者,以开放性手外伤为主,占总例数的96.00%,闭合性手外伤者仅占4.00%,且各年度间无明显差别。受伤侧别各年度间无统计学意义。调查的病例中,腕部以近及手掌部受损比率呈逐年下降趋势,其中上臂损伤比率下降趋势较为明显,1100例病例中含上臂损伤者23例,损伤率为2.09%;含前臂损伤者84例,损伤率7.64%;含手腕部损伤者85例,损伤率7.73%;含手掌部损伤者160例,损伤率14.55%;含手指部损伤者最多为880例,损伤率80.00%。手外伤受损部位由远端至近端受损比率呈递减趋势。(6)手指损伤者,含中指损伤者最多,400例占36.36%;其次为示指,372例占33.82%;第三位是环指,329例占29.91%。(7)多部位损伤者459例占41.73%,非多部位损伤者641例占58.27%。不同损伤类型多部位损伤发生率存在差异(=35.79 P0.0001)。1100例病例中,切割伤人数最多为430例,多部位损伤者168例占切割伤总例数的39.07%;绞伤320例,多部位损伤者174例,占绞伤总例数54.38%,超过一半。(8)从组织学的角度,皮肤损伤者所占比例最高,1056例(96.00%);肌腱次之761例(69.18%);骨关节损伤者720例(65.45%),这三部分占组织损伤的前三位。(9)手外伤患者中受伤时段以0时至5时就诊患者较少,其中2时和4时就诊患者最少;6时之后逐渐增加,9时出现第一个受伤高峰后逐渐下降,于13时再次上升,14时出现第二个受伤高峰,其后逐渐下降直至谷底。每天患者受伤人数最多的时间段为8时至17时,占总比例的65.00%。10月份就诊的患者最多,160例,占14.55%;其次为5月份,共120例,占10.91.%;其余月份均在10.00%以下;12月份就诊的伤者最少,共58例,占5.27%。四个季度病例分布呈逐渐上升趋势。受伤后2-4小时(不包括4小时)就诊者650例占59.09%。6小时以内就诊者达到95.36%。(10)手外伤损伤类型与患者的性别、年龄和职业均有关(P0.05)。(11)1100例手外伤患者中,最短住院1天,最长住院170天,平均住院时间为11.37天;住院费用最少为266.00元,最多为96944.00元,每例伤者住院费用平均为11130.61元。住院费用10000元及以上者454例,占41.27%。手外伤住院总费用呈逐年递增趋势,每人每天费用也呈逐年上升趋势。结论:1.男女性均可发生手外伤,但男性大于女性,男女之比为3.62:1;各年龄段均可发生手外伤,以38-47岁年龄组最高;手外伤患者中已婚者多见;以农民和初中文化程度者居多。2.手外伤中开放伤多于闭合伤,左手多于右手,手指受伤最多,其中中指受损的患者最多。多部位损伤略少于单部位损伤。3.损伤类型中工人以切割伤为主,而农民多为绞伤。受损的组织中皮肤最常见,其次为肌腱和骨关节。4.受伤时间多见于每日的9时和14时,10月份和第4季度;大多数患者能在伤后2-4小时就诊。5.手外伤损伤类型与患者的性别、年龄和职业有关。6.患者住院费用多数在10000元以上,每人每天住院费用呈逐年上升趋势。
[Abstract]:Objective: hand plays an important role in the production and life of human beings. With the improvement of mechanization level and the progress of industrialization, the incidence of hand injuries increases unabated. At present, the research of hand injury in China is mainly concentrated in the economically developed areas with high industrial level, the existence of differences in the population, the composition and distribution of hand injuries. The study on hand trauma in Northeast China is relatively few. There is no related report about hand trauma in Siping area. This study aims to collect and collate the data of 1100 cases of hand trauma hospitalized in January 2012 -2014 year of January 2012 in Siping City, Jilin province. To understand the characteristics and rules of hand trauma in Siping area, provide the basis for rational allocation of medical resources and reduce the occurrence of hand trauma. Methods: all cases were derived from 1100 cases of hand trauma in a hospital in Siping City, January 2012, December -2014 years. A retrospective study method was used, according to the research content, the statistical table was designed. The hospital electronic medical record system extracts the relevant information. The main contents include: the basic information of the patient: name, sex, age, occupation, marital status, educational level, admission year, admission month, date of admission, date of hospital discharge, hospital days, hospitalization expenses, medical treatment payment method. 2. Injury time period, injury to visit time, Injury side, injury site, damaged tissue, whether it was multiple sites, type of injury, and cause of injury. (3) the information of disease treatment: anesthesia and operation. Results: (1) in 1100 cases of inpatients with hand trauma, 862 cases were male, 78.36% were male, 238 women, and the proportion of 21.64%. male and female patients was only 1 with the lowest age of 3.62:1. (2). The age group was 89 years old and the average age was 38 years old. The age group with the largest number of hand injuries was 38-47 years old, 298 cases, 27.09%, followed by 48-57 years old and 19.45% in 214 cases, third in 28-37 years old and 204 in 18.55%; and the number of cases of hand trauma in the age group of 58 years of age At least, in 93 cases, only 8.45%. (3) accounted for the largest number of hand injuries in farmers, 587 cases, 53.36%, followed by workers and 304 cases, accounting for 27.64%, and the number of cases of cadres with hand injuries was the least, 57 cases, accounting for the highest proportion of patients with 5.18%. (4) in junior middle school, 52.18%, and the degree of 26.18% in primary school and below, and the University and above. The lowest proportion was 6.09%. (5) 1100 cases of hand trauma collected in this study, with open hand trauma mainly, accounting for 96% of the total number of cases, and only 4% of closed hand injuries. There was no significant difference between the year and the injured side. The incidence of proximal and palmar damage was declining year by year in the cases investigated. In 1100 cases, there were 23 cases of upper arm injury in 1100 cases, the injury rate was 2.09%, 84 cases with forearm injury, 7.64% injury rate, 85 wrist injuries, 7.73% injury rate, 160 cases with palmar injury, 14.55% of injury rate, and 880 cases with finger injury, and injury rate 80.00%. hand trauma. The damage ratio of damaged parts from distal to proximal end was decreased. (6) finger injuries were the most important, 400 cases accounted for 36.36%, followed by finger finger, 372 cases 33.82%, third was ring finger, 329 cases were 29.91%. (7) with 459 cases of 41.73%, 641 cases in non multiple trauma patients accounted for multiple damage types of different types of 58.27%. injury. Among the =35.79 P0.0001 cases, the number of.1100 cases was 430 cases, the number of incised injuries was the most, 168 cases were 39.07% of the total number of cutting injuries, 320 cases of strangulation and 174 cases of multiple site injury, which accounted for 54.38%, more than half. (8) from the histological point of view, the proportion of skin injuries was the highest, 1056 cases (96%), and 7 tendons 7. 61 cases (69.18%); 720 cases (65.45%) of bone joint injury (65.45%), and the three parts accounted for the first three of the tissue injury. (9) the injured period of the hand trauma patients was less in the case of 0 to 5, of which 2 and 4, the patients were least; after 6, the number of patients gradually increased. The peak of injury was gradually descended to the bottom of the valley. The maximum number of injured patients was 8 to 17 every day, which accounted for the largest number of patients in 65.00%.10 months, 160 cases, 14.55%, followed by May, 120 cases, 10.91.%, and the rest of the months under 10%; in December, 58 cases, accounting for four 5.27%., were the least. The quarterly case distribution was gradually rising. 2-4 hours after injury (not including 4 hours) 650 cases accounted for 95.36%. (10) of the patients within 59.09%.6 hours (10) of the type of hand injury and the sex, age and occupation of the patients (P0.05). (11) 1100 cases of hand trauma, the shortest hospitalization of 1 days, the longest hospitalization for 170 days, the average length of hospitalization 11.37 days, the cost of hospitalization was at least 266 yuan, the maximum was 96944 yuan, the average cost of hospitalization for each case was 11130.61 yuan. The hospitalization cost was 10000 yuan and more than 454 cases, the total hospitalization expenses of 41.27%. hand injuries increased year by year, and the daily expenses of each person were also increasing year by year. Conclusion: 1. men and women can have hand injury, but men are more than men. In women, the ratio of male and female is 3.62:1, hand trauma can occur in all age groups, the highest in the age group of 38-47 years, more of married people in hand trauma patients; more.2. hand trauma in farmers and junior middle school than closed injuries, left hand more than right hand, the most finger injuries, among which middle finger injured patients are the most. A little less than the damage of multiple sites. Among the types of.3. injury in single site, most of the workers were cut injury, and most of the peasants were twisted. The most common skin in the damaged tissues was the damaged tissue, followed by the time of the injury of tendon and bone joint.4. in 9 and 14 times a day, in the October and the fourth quarter; most of the patients were able to see the type of.5. hand injury and the sex of the patients at 2-4 hours after the injury. The cost of hospitalization for patients with.6. and occupation is mostly over 10000 yuan, and the hospitalization expenses per person are increasing year by year.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R658.2

【参考文献】