老年髋部骨折术前风险评估及风险预测方程的初步建立

发布时间：2018-06-20 23:46

本文选题：老年 + 髋部骨折　；参考：《泸州医学院》2014年硕士论文

【摘要】：目的：通过研究老年髋部骨折手术风险因素，对术前手术风险进行评估，，初步建立老年髋部骨折手术风险预测方程，以期术前对手术风险进行预测，指导老年髋部骨折患者临床处理。为进一步研究、完善方程，建立一个客观、准确、可靠的老年髋部骨折手术风险评估系统以及评估软件开发奠定基础。方法：通过收集2004年1月到2013年12月于我院住院手术治疗的546例老年髋部骨折患者临床资料对其进行回顾性研究。把收集的年龄、性别、术前检查资料、既往病史（术前合并症）、麻醉及手术方式、手术时间、术中失血量、术后并发症以及围手术期死亡等资料双输录入至Epidata3.1软件，在录入过程中进行逻辑纠错；将Epidata3.1软件处理后的数据导入spss16.0软件进行统计分析：先采用χ2及t检验等方法进行变量的初筛去除无意义变量（以=0.05为检验水准，P值0.05变量有统计学意义）、排除干预措施质量对结果的影响，筛选后采用逐步判别法进行判别分析（判别分析调用spss软件中Discriminant过程实现），得到有意义变量及变量系数从而建立预测方程。并对方程进行组内回代，对回代情况进行分析。结果：收集老年髋部骨折手术治疗患者546例,男：223例，女：323例；初筛后剩余518例，原始判断为“1”的108例，原始判断为“0”的410例；通过统计分析，得到术前手术风险预测方程为： Y=0.042Xwbc+0.004Xbcr+0.515Xnyha+0.227Xmmse+0.594Xxxghb+1.513Xhxhb+1.189Xmnhb+2.703Xqqhb-2.138；上述方程中各变量对判别结果的作用大小可以用标准化系数估计，上述变量的标准化系数分别为：Xwbc（白细胞计数单位x109/L）0.154, Xbcr(血肌酐单位umol/L)0.222，Xnyha（心功能分级）0.357，Xmmse（简易智力状况检查）0.171，Xxxghb（心血管系统合并症）0.213，Xhxhb（呼吸系统合并症）0.553，Xmnhb（泌尿系合并症）0.270，Xqqhb（其他肿瘤、消耗性疾病等合并症）0.419；方程行组内回代，合计术前手术风险预测正确率：84.0%。将某样本的相关变量值代入预测方程，求出的判别分Y0的界定为风险性“1”级，判别分Y0的界定为风险性“0”级。判别为“1”级表示：预测术前手术风险高，手术安全概率小。判别为“0”级表示：预测术前手术风险低，手术安全概率大。判别风险性为0级的中心得分点为-0.413，判别风险性为1级的中心得分点为1.568。结论：（1）老年髋部骨折患者手术风险因素对预测结果作用的大小可以用标准化系数表示，其中呼吸系统合并症是最为重要的风险因素，其次为心血管系统合并症。（2）老年髋部骨折术前手术风险预测方程： Y=0.042Xwbc+0.004Xbcr+0.515Xnyha+0.227Xmmse+0.594Xxxghb+1.513Xhxhb+1.189Xmnhb+2.703Xqqhb-2.138；术前手术风险预测由预测方程来完成，对方程组内回代的结果合计术前手术风险预测正确率：84.0%。该方程可用于老年髋部骨折患者手术风险的初步判断。
[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.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R687.3

【参考文献】