通过教育干预减少冲压机械致工业性手外伤的病例对照研究

Educational intervention reduces industrial hand injuries by punch machines： a case-control study

目的通过教育干预影响冲压机械致工业性手外伤的危险因素，比较其发病频率的变化。方法于2010年3月至6月期间进入事故高发单位进行安全宣教。通过问卷调查收集2009年和2010年7月至8月，在复旦大学附属中山医院青浦分院就诊的急诊工业性手外伤患者资料，共906例。按年份将患者分为2009年（宣教前）组和2010年（宣教后）组，对两组数据进行分类、汇总，采用卡方检验进行统计学分析。结果采取教育干预后对2009年组和2010年组进行比较，冲压机械所致工业性手外伤发病频率的差异有统计学意义（X2=10．99，v=1，P〈0．01）。两组致伤原因相比，无上岗前培训与有上岗前培训两组差异有统计学意义（X2=5．36，v=1，P〈0．05），而本工种工龄不到1年、事故机器使用时间大于10年及每日工作时间在8h以上两组比较差异均无统计学意义（X2=2．50、0、0．14，v均为1，P〉0．05）。结论教育干预可预防因冲压机械所致的工业性手外伤的发生，加强安全防护装置的应用和安全操作规章的贯彻实施也是必要的措施。通过多手段联合干预应可有效地降低冲压机械所致工业性手外伤的发生频率。

Objective To affect the possible risk factors of industrial hand injuries by punch machines through educational intervention and compare the incidence of injury before and after the intervention. Methods Occupation safety education was conducted during March to June of 2010 in factories with high incidence of machinery hand injuries. A retrospective investigation was carried out via questionnaires sent to 906 patients who sustained industrial hand injuries during 2009 and during July to August of 2010 and who were treated in Qinpu Branch of Zhongshan Hospital, Fudan University. These patients were divided into 2009 group （before intervention group） and 2010 group （after intervention group）. The results from these two groups were categorized, summarized and analyzed using chi-square test. Results The incidence of industrial hand injuries by punch machines was significantly reduced after educational intervention （ X2 = 10.99, v = 1, P 〈 0.01 ）. Causes of the injuries were significantly different between workers who had pre-job training and who did not have pre-job training （X2 = 5.36,v = 1, P 〈 0.05）. There were no significant differences between the two groups with regard of less than 1 year working experience, more than 10 years use of the accident machine, and more than eight hours daily working hours （X2 = 2.50, X2 = 0 and X2 = 0.14, respectively; v = 1, P 〉 0.05）. Conclusion Educational intervention can prevent industrial hand injuries caused by punch machines. Proper use of protective devices and compliance and execution of safety regulations are key measures. Comprehensive intervention strategies can effectivelv reduce the injury incidence.