【作者】 赵丹；

【导师】 李丽萍；

【作者基本信息】 汕头大学 ， 流行病与卫生统计学， 2007， 硕士

【摘要】 背景和目的伤害已成为全球面临的严重威胁人民健康的重要公共卫生问题之一，制约了社会经济的发展。为了有效防制伤害，研究者和政府相关部门均需要获得准确、可靠、全面的伤害发生的信息。目前，在国内的伤害研究中主要使用的是二手资料，如统计报表、住院病历、报刊杂志、文献资料等。人群伤害的现况调查既可阐明特定人群伤害发生的频率、分布特点和原因，又可搜集到伤害发生的详细过程和未到医院诊治的伤害的调查对象。以社区为单位进行现况调查，针对性更强，更能准确说明特定人群伤害发生的主要伤害类型、危险环境及其危害程度。随着社区卫生服务的开展，社区卫生服务单位需要根据具体情况制定相应的计划与措施，进行社区伤害的防制工作，逐步构建在社区水平上进行伤害预防的安全社区模式。因此，我们应该积极开展社区伤害研究工作。本次研究选择南澳县为调查地区，主要考虑它作为海岛县城的较特殊的地理位置，其地理环境相对孤立且稳定，人口相对固定，且岛上只有唯一的一家综合性医院，有利于开展当地人群调查，较为准确全面地记录、分析伤害发生情况的资料。本研究分析南澳县人民医院在过去12年的住院病例中伤害的发生情况，首次将同一地区同期内社区居民伤害情况的现况调查结果与医院伤害监测结果结合起来，全面分析其伤害发生的流行病学特点及伤害患者的就诊特点，为政府主管部门全面了解当地伤害发生全貌提供科学依据，也为我国进一步的伤害预防研究提供基础资料。方法1．收集南澳县人民医院1994-2005年期间住院病人的病历资料，应用Excel建立数据库。2．根据世界卫生组织推荐的社区调查方案，随机选择512户1638名社区居民。采用入户问卷调查方法，调查员按照统一方法亲自询问并填写社区居民伤害情况调查表(2005．7．1-2006．7．3 1)，应用FoxPr08．0建立数据库。3．收集南澳县人民医院及云澳、青澳卫生院医务人员填写的伤害监测报告卡(2006．4．1-7．31)，应用FoxPr08．0建立数据库。经审查和复核数据库后，采用SPSS13．0统计软件进行描述性统计和卡方检验。结果1．在12年期间共有7016人次住院，因受到伤害而住院治疗的有960人次(占13.68％)，其中男性715人次(占74.48％)、女性245人次(25.52％)。在住院病例中，伤害病例人次和伤害住院病例占的比例总体呈逐年上升趋势。2．在一年期间，16个社区居民共发生各类伤害754人次，总发生人次率为43.28％，伤害发生率为40.60％，标化发生率为43.25％。伤害发生率前三位依次为钝／锐器伤、跌倒／坠落、烧烫伤。发生伤害的男性有421人次(占55.84％)，女性有333人次(占44.16％)，且男、女性伤害发生率比较有统计学意义。男／女性均是钝／锐器伤的发生率最高。钝／锐器伤的发生率男性比女性高，64.52％发生在31～55岁年龄段，45.50％发生于农牧渔水利生产人员(其中渔民占63.60％)。跌倒／坠落伤多发生在1～15岁、41～55岁及60岁以上年龄段(占77.53％)，47.19％发生于学龄前儿童和学生。烧烫伤的发生率女性比男性高，46.15％发生在做家务的人群。3．南澳县居民在2006年4月1日～7月31日期间共有211人次因受到伤害到南澳县人民医院、青澳镇卫生院、云澳镇卫生院就诊，其中男性147人次(占69.67％)，女性64人次(占30.33％)。所占比例前三位的依次为钝／锐器伤、打架／斗殴、跌倒／坠落。同期内，社区居民发生伤害362人次，其中男性217人次(占59.94％)，女性145人次(占40.06％)。4．同一时期的社区居民伤害情况调查结果与医院伤害监测结果的比较，受伤居民中各伤害类型所占比例不同，伤害程度也不同。结论1．12年来，在住院病例中伤害病例人次和伤害住院病例占的比例总体呈逐年上升趋势。2．社区居民伤害情况调查结果表明，南澳县受伤害人群男性多于女性，男性的受伤类型以钝／锐器伤、交通伤等为主，而女性以烧烫伤为主。受伤害者集中于青壮年，高危人群为农牧渔水利业生产人员、在校学生和家务人员。3．医院伤害监测资料显示，农牧渔水利生产人员和在校学生的受伤类型以打架／斗殴，为主，学龄前儿童则以跌倒／坠落为主，伤害好发于36～45岁年龄段。4．现况调查与医院伤害监测两种方法收集的资料可以相互印证、相互补充，能较全面地反映一个地区的伤害情况，可获得伤害患者的人数、因伤害住院／死亡的人数、伤害发生率、各种伤害种类及伤害程度的比例等。更多还原

【Abstract】 Background & Objectives Injury became an important pulic health problem, badly threaten people health and restricted the development of community economy. Along with more and more conturies were cognizant of injury ponderance and impendence of prevention and control, investigators and government departments all want to obtain exact, credible and general information of injury occurring. At present injury researches mostly use the secondhand data in our country, such as statistics、medical record、newspapers and periodicals、literatures. A cross-sectional research on injuries among residents can clarify injury occurring frequency、distribuing and cause of specific crowd, collect particular course of injury and the rest without going to hospital make a diagnosis and give treatment. A cross-sectional research with community as unit, pertinency is better and explain danger circumstance and harm of injury more exactly, offering more ample scientific basis for decision-making. Along with the developing of community health serving, community health serving units demand to make corresponding programs and measures based on practical instance, carry through prevention and control, construct the mode of safety community to prevent injury at community level step by step. So, these request us to develop community injury study. This research chooses Nan’ao as investigation area, because its geography location is especial. The country is an island, circumstance correspondingly isolated and steady and population is immobile. There has an only integrative hospital. These are propitious to investigate、note and analyze the data of injury occurring exactly and roundly. We will analyze the injury instance of inpatient in Nan’ao hospital during the past twelve years and combine the result of cross-sectional research and hospital-based injury surveillance. Expatiating epidemiology characteristic of injury and residents hospitalize action in order to provide the scientific basis to know injury instances and use the data for govemment departments and provide the foundation data to research on injury for methodology. Methods Collecting the case history of inpatient in Nan’ao hospital, establishing data-base by Excel. Random sampling 512 families, 1638 residents base on guidelines for conducting community surveys on injuries and violence which was commended by World Health Organization. Inquirers filled in the injury instance questionary of community residents by household questionnaire, establishing data-base by FoxPro8.0. Collecting the injury surveillance card from Nan’ao hospital and its two subordinate hospital, establishing data-base by FoxPro8.0. After data-bases were examined and checked, they were description analyzed and Chi-square tested with SPSS 13.0 for Windows.Results 1. There were 7016 person-time who were in hospital during the twelve years, 960 person-time(13.68％) were in hospital because of injury. Thereinto 715 person-time male (74.48％) and 245 female (25.52％). Among the inpatient who were in hospital, injury person-time and the proportion of injury inpatients were ascending year after year as a whole 2. There were 754 person-time of 16 community residents who were injuried during the last year, incidence rate(person-time) is 43.28％. The first three of incidence rate were blunt/sharp object injury, tumble/fall and bum/scald. There were 421 person-time male(55.84％) and 333 person-time female(44.16％). Comparing the male incidence rate with the female, there had statistical significance. The incidence rate of blunt/sharp object injury was the most in the male/female, and the male’s was higher than the female’s. 64.52％were happened in the crowd of 31～55 years old, 45.50％were happened in the crowd, such as farmer、fisher. Subjects in the age range of 1～15 years、41～55 years and 60 years upwards were most likely to tumble/fall, 47.19％were happened in the preschool children and students. Burn/scald incidence rate of the male was higher than the female, 46.15％were happened in the crowd of doing housework.3. There were 211 person-time of residents of Nan’ao who were injuried to the hospital during the April 1 to July 31 of last year, thereinto 147 person-time male(69.67％) and 64 female(30.33％). The first three of proportion were blunt/sharp object injury、fight/bustup and tumble/fall. In the same term, country residents who were occurred injury were 362 person-time, thereinto 217 person-time male(59.94％) and 145 female (40.06％). 4. Comparing the result of research on injuries among residents with the result of injury surveillance in hospital. Different injury types accounted for different proportion and injury degree were different too. Conclusions 1. Among the inpatient who were in hospital during the twelve years, injury person-time and the proportion of injury inpatients were ascending year after year as a whole. 2. The result of cross-sectional study on injuries among residents indicated, the male were more than the female among the injury crowd of Nan’ao, the primary injury type of the male were blunt/sharp object injury、traffic injury, the female were burn/scald. The people who were in injuried fastened youth and midlife, farmers、fishers、students and the crowd of doing housework were the crowd who had high dangerous to be injured. 3. The data of hospital-based surveillance showed, the primary injury type of farmers、fishers and students were fight/bustup, the preschool children were tunable/fall. Injury were mostly occurred on 36～45 years old. 4. The data of cross-sectional study and hospital-based surveillance can be verified and complemented one another. They can relative roundly reflected the injury occurring of an area. We can obtained the number of injury sufferers and injury inpatients/death、injury incidence rate、the proportion of various injury types and degree etc.更多还原