本文選題：手外傷 + 住院病例��； 參考：《吉林大學(xué)》2015年碩士論文

【摘要】：目的:手在人類的生產(chǎn)和生活中起著舉足輕重的作用。隨著機(jī)械化水平的提高和工業(yè)化的進(jìn)展,手外傷的發(fā)生率有增無(wú)減。目前,我國(guó)手外傷的研究多集中在經(jīng)濟(jì)發(fā)達(dá)、工業(yè)化水平高的地區(qū),由于地區(qū)、人群存在差異,手外傷的構(gòu)成和分布也存在較大差異。查閱相關(guān)資料,關(guān)于東北地區(qū)手外傷研究相對(duì)較少,尚無(wú)關(guān)于四平地區(qū)手外傷研究的相關(guān)報(bào)道。本次研究旨在通過(guò)系統(tǒng)的收集和整理吉林省四平市某醫(yī)院收治的2012年1月-2014年12月1100例手外傷住院患者的病例資料,以期了解四平地區(qū)手外傷發(fā)生特點(diǎn)及規(guī)律,為合理配置醫(yī)療資源、減少手外傷的發(fā)生提供依據(jù)。方法:所有病例來(lái)源于四平市某醫(yī)院2012年1月-2014年12月期間的手外傷住院患者,共1100例。采用回顧性的研究方法,根據(jù)研究?jī)?nèi)容,設(shè)計(jì)統(tǒng)計(jì)表,從醫(yī)院電子病歷系統(tǒng)中提取相關(guān)信息。其內(nèi)容主要包括:⑴患者基本信息:姓名、性別、年齡、職業(yè)、婚姻狀況、文化程度、入院年份、入院月份、入院日期、出院日期、住院天數(shù)、住院費(fèi)用、醫(yī)療付款方式。⑵患者疾病信息:損傷時(shí)段、損傷到就診時(shí)間、損傷側(cè)別、損傷部位、損傷組織、是否為多部位、損傷類型、損傷原因。⑶疾病治療信息:麻醉方式、手術(shù)方式。結(jié)果:(1)1100例手外傷住院患者中,男性患者862例,占78.36%,女性238例,占21.64%。男性患者與女性患者的比例為3.62:1。(2)年齡最小者僅為1歲,年齡最大者89歲,平均年齡為38歲,其中發(fā)生手部損傷人數(shù)最多的年齡組為38-47歲,為298例,占27.09%;其次是48-57歲年齡組,214例占19.45%;第三位是28-37歲年齡組,204例占18.55%;58歲及以上者102例占9.27%;而18歲年齡組的人群發(fā)生手外傷的例數(shù)最少,為93例,僅占8.45%。(3)農(nóng)民發(fā)生手外傷人數(shù)最多,587例,占53.36%,其次為工人,304例,占27.64%,而干部發(fā)生手外傷的例數(shù)最少,為57例,占總患者的5.18%。(4)初中文化程度患者所占比例最高,為52.18%;小學(xué)及以下文化程度占26.18%;大學(xué)及以上所占比例最低,為6.09%。(5)本次研究收集的1100例手外傷患者,以開放性手外傷為主,占總例數(shù)的96.00%,閉合性手外傷者僅占4.00%,且各年度間無(wú)明顯差別。受傷側(cè)別各年度間無(wú)統(tǒng)計(jì)學(xué)意義。調(diào)查的病例中,腕部以近及手掌部受損比率呈逐年下降趨勢(shì),其中上臂損傷比率下降趨勢(shì)較為明顯,1100例病例中含上臂損傷者23例,損傷率為2.09%;含前臂損傷者84例,損傷率7.64%;含手腕部損傷者85例,損傷率7.73%;含手掌部損傷者160例,損傷率14.55%;含手指部損傷者最多為880例,損傷率80.00%。手外傷受損部位由遠(yuǎn)端至近端受損比率呈遞減趨勢(shì)。(6)手指損傷者,含中指損傷者最多,400例占36.36%;其次為示指,372例占33.82%;第三位是環(huán)指,329例占29.91%。(7)多部位損傷者459例占41.73%,非多部位損傷者641例占58.27%。不同損傷類型多部位損傷發(fā)生率存在差異(=35.79 P0.0001)。1100例病例中,切割傷人數(shù)最多為430例,多部位損傷者168例占切割傷總例數(shù)的39.07%;絞傷320例,多部位損傷者174例,占絞傷總例數(shù)54.38%,超過(guò)一半。(8)從組織學(xué)的角度,皮膚損傷者所占比例最高,1056例(96.00%);肌腱次之761例(69.18%);骨關(guān)節(jié)損傷者720例(65.45%),這三部分占組織損傷的前三位。(9)手外傷患者中受傷時(shí)段以0時(shí)至5時(shí)就診患者較少,其中2時(shí)和4時(shí)就診患者最少;6時(shí)之后逐漸增加,9時(shí)出現(xiàn)第一個(gè)受傷高峰后逐漸下降,于13時(shí)再次上升,14時(shí)出現(xiàn)第二個(gè)受傷高峰,其后逐漸下降直至谷底。每天患者受傷人數(shù)最多的時(shí)間段為8時(shí)至17時(shí),占總比例的65.00%。10月份就診的患者最多,160例,占14.55%;其次為5月份,共120例,占10.91.%;其余月份均在10.00%以下;12月份就診的傷者最少,共58例,占5.27%。四個(gè)季度病例分布呈逐漸上升趨勢(shì)。受傷后2-4小時(shí)(不包括4小時(shí))就診者650例占59.09%。6小時(shí)以內(nèi)就診者達(dá)到95.36%。(10)手外傷損傷類型與患者的性別、年齡和職業(yè)均有關(guān)(P0.05)。(11)1100例手外傷患者中,最短住院1天,最長(zhǎng)住院170天,平均住院時(shí)間為11.37天;住院費(fèi)用最少為266.00元,最多為96944.00元,每例傷者住院費(fèi)用平均為11130.61元。住院費(fèi)用10000元及以上者454例,占41.27%。手外傷住院總費(fèi)用呈逐年遞增趨勢(shì),每人每天費(fèi)用也呈逐年上升趨勢(shì)。結(jié)論:1.男女性均可發(fā)生手外傷,但男性大于女性,男女之比為3.62:1;各年齡段均可發(fā)生手外傷,以38-47歲年齡組最高;手外傷患者中已婚者多見;以農(nóng)民和初中文化程度者居多。2.手外傷中開放傷多于閉合傷,左手多于右手,手指受傷最多,其中中指受損的患者最多。多部位損傷略少于單部位損傷。3.損傷類型中工人以切割傷為主,而農(nóng)民多為絞傷。受損的組織中皮膚最常見,其次為肌腱和骨關(guān)節(jié)。4.受傷時(shí)間多見于每日的9時(shí)和14時(shí),10月份和第4季度;大多數(shù)患者能在傷后2-4小時(shí)就診。5.手外傷損傷類型與患者的性別、年齡和職業(yè)有關(guān)。6.患者住院費(fèi)用多數(shù)在10000元以上,每人每天住院費(fèi)用呈逐年上升趨勢(shì)。
[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.

【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R658.2

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