本文選題：老年 + 髖部骨折　； 參考：《瀘州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的：通過研究老年髖部骨折手術(shù)風(fēng)險(xiǎn)因素，對(duì)術(shù)前手術(shù)風(fēng)險(xiǎn)進(jìn)行評(píng)估，，初步建立老年髖部骨折手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)方程，以期術(shù)前對(duì)手術(shù)風(fēng)險(xiǎn)進(jìn)行預(yù)測(cè)，指導(dǎo)老年髖部骨折患者臨床處理。為進(jìn)一步研究、完善方程，建立一個(gè)客觀、準(zhǔn)確、可靠的老年髖部骨折手術(shù)風(fēng)險(xiǎn)評(píng)估系統(tǒng)以及評(píng)估軟件開發(fā)奠定基礎(chǔ)。方法：通過收集2004年1月到2013年12月于我院住院手術(shù)治療的546例老年髖部骨折患者臨床資料對(duì)其進(jìn)行回顧性研究。把收集的年齡、性別、術(shù)前檢查資料、既往病史（術(shù)前合并癥）、麻醉及手術(shù)方式、手術(shù)時(shí)間、術(shù)中失血量、術(shù)后并發(fā)癥以及圍手術(shù)期死亡等資料雙輸錄入至Epidata3.1軟件，在錄入過程中進(jìn)行邏輯糾錯(cuò)；將Epidata3.1軟件處理后的數(shù)據(jù)導(dǎo)入spss16.0軟件進(jìn)行統(tǒng)計(jì)分析：先采用χ2及t檢驗(yàn)等方法進(jìn)行變量的初篩去除無意義變量（以=0.05為檢驗(yàn)水準(zhǔn)，P值0.05變量有統(tǒng)計(jì)學(xué)意義）、排除干預(yù)措施質(zhì)量對(duì)結(jié)果的影響，篩選后采用逐步判別法進(jìn)行判別分析（判別分析調(diào)用spss軟件中Discriminant過程實(shí)現(xiàn)），得到有意義變量及變量系數(shù)從而建立預(yù)測(cè)方程。并對(duì)方程進(jìn)行組內(nèi)回代，對(duì)回代情況進(jìn)行分析。結(jié)果：收集老年髖部骨折手術(shù)治療患者546例,男：223例，女：323例；初篩后剩余518例，原始判斷為“1”的108例，原始判斷為“0”的410例；通過統(tǒng)計(jì)分析，得到術(shù)前手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)方程為： Y=0.042Xwbc+0.004Xbcr+0.515Xnyha+0.227Xmmse+0.594Xxxghb+1.513Xhxhb+1.189Xmnhb+2.703Xqqhb-2.138； 上述方程中各變量對(duì)判別結(jié)果的作用大小可以用標(biāo)準(zhǔn)化系數(shù)估計(jì)，上述變量的標(biāo)準(zhǔn)化系數(shù)分別為：Xwbc（白細(xì)胞計(jì)數(shù)單位x109/L）0.154, Xbcr(血肌酐單位umol/L)0.222，Xnyha（心功能分級(jí)）0.357，Xmmse（簡易智力狀況檢查）0.171，Xxxghb（心血管系統(tǒng)合并癥）0.213，Xhxhb（呼吸系統(tǒng)合并癥）0.553，Xmnhb（泌尿系合并癥）0.270，Xqqhb（其他腫瘤、消耗性疾病等合并癥）0.419；方程行組內(nèi)回代，合計(jì)術(shù)前手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)正確率：84.0%。將某樣本的相關(guān)變量值代入預(yù)測(cè)方程，求出的判別分Y0的界定為風(fēng)險(xiǎn)性“1”級(jí)，判別分Y0的界定為風(fēng)險(xiǎn)性“0”級(jí)。判別為“1”級(jí)表示：預(yù)測(cè)術(shù)前手術(shù)風(fēng)險(xiǎn)高，手術(shù)安全概率小。判別為“0”級(jí)表示：預(yù)測(cè)術(shù)前手術(shù)風(fēng)險(xiǎn)低，手術(shù)安全概率大。判別風(fēng)險(xiǎn)性為0級(jí)的中心得分點(diǎn)為-0.413，判別風(fēng)險(xiǎn)性為1級(jí)的中心得分點(diǎn)為1.568。結(jié)論：（1）老年髖部骨折患者手術(shù)風(fēng)險(xiǎn)因素對(duì)預(yù)測(cè)結(jié)果作用的大小可以用標(biāo)準(zhǔn)化系數(shù)表示，其中呼吸系統(tǒng)合并癥是最為重要的風(fēng)險(xiǎn)因素，其次為心血管系統(tǒng)合并癥。 （2）老年髖部骨折術(shù)前手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)方程： Y=0.042Xwbc+0.004Xbcr+0.515Xnyha+0.227Xmmse+0.594Xxxghb+1.513Xhxhb+1.189Xmnhb+2.703Xqqhb-2.138； 術(shù)前手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)由預(yù)測(cè)方程來完成，對(duì)方程組內(nèi)回代的結(jié)果合計(jì)術(shù)前手術(shù)風(fēng)險(xiǎn)預(yù)測(cè)正確率：84.0%。該方程可用于老年髖部骨折患者手術(shù)風(fēng)險(xiǎn)的初步判斷。
[Abstract]:Objective: to study the operative risk factors of hip fracture in the elderly and evaluate the preoperative risk of hip fracture, and establish the prediction equation of the surgical risk of hip fracture in the elderly, in order to predict the risk of operation before operation. To guide the clinical management of elderly patients with hip fracture. For further study, perfect equation, establish an objective, accurate, reliable elderly hip fracture surgery risk assessment system and the development of evaluation software. Methods: from January 2004 to December 2013, 546 elderly patients with hip fracture were retrospectively studied. The collected data of age, sex, preoperative examination, previous medical history (preoperative complications, anesthesia and operation methods, operative time, intraoperative blood loss, postoperative complications and perioperative death) were inputted into Epidata3.1 software. Carry on logic correction in the process of inputting; The data processed by Epidata 3.1 software were imported into spss16.0 software for statistical analysis. First, the methods of 蠂 2 and t test were used to remove the meaningless variables. The effect of the quality of pre-measures on the results, After screening, the discriminant process is realized by using discriminant process in spss software by discriminant analysis. The significant variables and their coefficients are obtained and the prediction equation is established. At the same time, the equation was analyzed. Results: a total of 546 elderly patients with hip fracture were treated by surgery, including 223 males and 323 females, 518 cases remaining after primary screening, 108 cases with original judgment of "1" and 410 cases with original judgment of "0". The preoperative risk prediction equation is as follows: YP0.042Xwbc 0.004Xbcr 0.515Xnyha 0.227Xmmse 0.594Xxghb 1.513Xhxhb1.189Xmnhb 2.703Xqqqhb-2.138. The standardized coefficients of the above variables are: Xwbc (leukocyte count unit x 109 / L = 0.154), Xbcra (serum creatinine unit umol / L = 0.222) Xnyha (cardiac function grade 0.357) Xmmse0.171 X xxghb (cardiovascular system complications 0.213 Xhxhbb) (respiratory complications 0.270Xqqhbb). Expendable diseases and other complications were 0.419; the equation was used for intra-group generation, and the correct rate of preoperative risk prediction was: 84.0%. The relative variable value of a sample is substituted into the prediction equation, and the discriminant score Y0 is defined as the risk "1" class, and the discriminant sub-Y _ 0 is defined as the risk "0" level. The discriminant "1" indicates that the risk of preoperative operation is high and the probability of operation safety is small. The discriminant "0" indicates that the risk of preoperative operation is low and the probability of operation safety is high. The center score of 0 grade is -0.413, and that of 1 grade is 1.568. Conclusion (1) the effect of surgical risk factors on predicting results in elderly patients with hip fracture can be expressed by standardized coefficient, among which respiratory complications are the most important risk factors. The prediction equation of preoperative surgical risk of hip fracture in elderly patients was: YP0.042Xwbc 0.004Xbcr 0.515Xnyha 0.227Xmmse 0.594Xxxghb 1.513Xhxhhb 1.189Xmnhb 2.703Xqqhb-2.138. The correct rate of preoperative risk prediction was: 84.0%. The equation can be used to estimate the surgical risk in elderly patients with hip fracture.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R687.3

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