冲压机械致工业性手外伤危险因素的病例对照研究

A Case-Control Study of Industrial Hand Injuries by Punch Machines

目的：了解冲压机械所致工业性手外伤的危险因素和有事故倾向性的人群。方法采用1：2配比的病例对照研究方法，对收治的冲压机械所致急诊工业性手外伤患者及其对照人群开展可能危险因素的调查。采用SPSS软件进行单因素分析和多因素条件Logistic回归模型拟合。多因素条件Logistic回归模型拟合时采用逐步回归分析方法，将变量引入模型的显著性水平设为0.05。共有符合条件的病例94例，因各种原因而未进入调查7例，最后获得有效配对87对进入分析。结果多因素 Logistic回归分析结果显示：每日工作时间和伤前工时越长，发生工业性手外伤的危险性越大，OR值分别为1.50和1.22。使用机械安全装置和贯彻安全操作规程与否是手外伤发生的主要危险因素，其OR值分别为0.26和0.35。结论每日工作时间过长者是具有事故倾向性的人群。在完善安全防护装置和贯彻实施安全操作规程的同时，加强对该亚人群的保护，可降低冲压机械所致工业性手外伤的发生频率。

Objective To identify factors associated with industrial hand injuries by punch machines. Methods From Jun 2010 to Jun 2011, 87 patients of industrial hand injuries by punch machines were collected. For each patient, 2 controls were randomly selected. One was from the same industry; the other was from a big industry with thousands of punch machines. They marched on gender, jobs and age. In-persons interviews were conducted to collect data on demographics, work history, work characteristics, work injuries, work organization, health behaviors, anthropometric and psychological factors. Risk factors were examined via multivariate logistic regression techniques. Results There were four important factors affecting hand injuries by punch machines： the first was the length of daily working time index （odds ratio [OR]1.50, 95% confidence interval [CI]=1.12, 1.32）. The second index was working hours before injury （OR=1.22, 95%CI=1.02, 1.27）. A safety equipment index （OR=0.26, 95%CI=0.12, 0.56） and a safety operation criterion index （OR=0.35, 95%CI=0.31, 0.41） were also significant factors. Conclusion Results suggest that the accident-prone population are those who have shorter service length and working hours. It may reduce the incidence of industrial hand injuries by punch machine to strengthen the appliance of safety equipment and enforcement of safety operation criterion, especially to the accident -prone population.