毕业论文设计中青年股骨头坏死患者延迟就医行为影响因素分析医学论文.docx

1、毕业论文设计中青年股骨头坏死患者延迟就医行为影响因素分析医学论文 中青年股骨头坏死患者延迟就医行为影响因素分析摘要背景 股骨头坏死是骨科的一种常见疾病，由于其病因及发病机制尚不明确，很多股骨头坏死患者在就医时已拖延至中晚期，严重影响临床治疗效果及生活质量。根据有关推测，我国需治疗股骨头坏死的患者约500750万人，每年新发病例有1520万1。发病也呈年轻化趋势，疾病人群以3050岁的中青年为主2。2年内发展为双侧股骨头坏死概率为72%3。同时现阶段国内外对于股骨头坏死延迟就医影响因素的研究尚没有开展。目的 探讨中青年股骨头坏死患者延迟就医的相关因素。具体从社会人口学资料、疾病情况、社会家庭支持

2、系统、自我效能及生存质量多方面共同讨论股骨头坏死患者延迟就医的可能因素，并探索各因素产生的影响程度以及疾病不同分期其影响因素的差别。方法 本研究通过患者基本资料问卷、疾病情况问卷、简易疾病认知问卷（Brief-IPQ)、慢性病自我效能量表（SEMCD-6）和生存质量量表SF12v2六部分内容对121位符合研究纳入标准的患者进行调查，调查对象为方便抽样产生，最终收集到106份有效问卷。数据采用双人核查，剔除无效问卷，并将数据录入SPSS20.0进行再次核查；计量资料采用均数、标准差的形式表示，计数资料采用例数表示。采用相关性分析和非参数检验进行延迟就医行为影响因素分析。结果 1.研究对象的延迟情

3、况从2天到长达七年不等，平均为83.495.5天（11.913.6周）。就医延迟时长的中位数为6周。2.研究对象的股骨头坏死分期情况为，0期占0.9%，期占6.6%，期占42.5%，期占34.9%，期占13.2%。3.研究对象的就医决策时长和疾病分期呈正相关，spearman检验相关系数为r=0.469，P=0.000。4.影响因素和时长经spearman相关性分析有统计学意义的有：文化（r=0.026，P=0.034）、疾病认知（r=-0.191，P=0.05）、情绪影响（r=0.283，P=0.003）、活动受限程度（r=-0.220，P=0.024）；经卡方检验影响因素和股骨头坏死分期有

4、统计学意义的有：年龄分组（2 =38.135,P=0.000)、婚姻（2 =15.917， P=0.044）、职业（2 =44.428，P=0.001）；影响因素与是否延迟经非参数秩和检验有统计学意义的有：社会家庭支持（Z=1.991,P=0.046）、主观支持（Z=2.990，P=0.003)、疾病影响（Z=2.221，P=0.026)、治疗控制（Z=-2.004，P=0.045）、保健行为（Z=-2.668，P=0.008）、生理健康（Z=-2.483，P=0.013）。结论1.股骨头坏死就医延迟的现状十分严重，九成以上患者在疾病中期首次入院就诊。2.股骨头坏死分期和就医延迟时长有关，延迟

5、时间越久，疾病分期越晚。3.股骨头坏死延迟就医的影响因素可能有：年龄、婚姻、文化程度、疾病认知、情绪影响、社会家庭支持、日常保健行为及生理健康。 关键词：股骨头坏死，延迟就医，影响因素STUDY ON THE INFLUENCING FACTORS OF YOUNG AND MIDDLE-AGED ONFH PATIENTS DELAY IN SEEKING TREATMENTABSTRACTBackground ONFH(Osteonecrosis Of The Femoral Head) is a common orthopedic disease. Due to the unclearn

6、ess of ONFHs etiology and pathogenesis, ONFH patients often seek medical treatment until they have approached the later period of illness, which severely impair their clinical results of treatment and living qualities. According to some related tentative data, there are about 57.5 million patients s

7、uffered ONFH in need of medical care. And there are an estimated 150200 thousand cases of ONFH annually. In recent years, the prevalence of the ONFH tends to be younger, which is in the 3050 year range. Meanwhile, there are no domestic and international research about the influencing factors of ONFH

8、 patients delay in seeking treatment at this stage.Objective To explore the influencing factors of young and middle-aged ONFH patients delay in seeking treatment. Analyzing the possible influencing factors from demographic information, clinical data, social family support systems, self efficacy and

9、quality of life. And exploring the degree of various factors and the difference among each disease stage.Method Using basic information questionnaire, disease situation questionnaire, Brief Illness Perception Questionnaire (Brief IPQ), Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD-6

10、) and Short Form 12 Health Survey (SF12-V2) to investigate 121 patients who accord with the inclusive criteria. The objects of investigation are selected by convenient sampling. And 106 of them are valid questionnaires. The data is double checked and input into SPSS 20.0 and rechecked. The measureme

11、nt data is represented in the form of mean and standard deviation, the enumeration data is represented in the form of cases number. Analyzing the possible influencing factors by correlation analysis and non-parametric test.Results 1. The elapsed time from symptom discovery to the initial seeking for

12、 a medical consultation ranged from 2 days to 7 years, 2. The ratio of ONFH clinical stages of 0, , , , is 0.9%, 6.6%, 42.5%, 34.9%, 13.2%. 3. There is a positive correlation between the elapsed time and the clinical stage of ONFH (r=0.469,P=0.000). 4. The influencing factors and elapsed time analyz

13、ed by spearman rank correlation have statistical significance are: education(r=0.026, P=0.034), age group(r=0.315, P=0.001), illness perception(r=-0.191, P=0.05), emotional impact(r=0.283, P=0.003), activity limitation(r=-0.220, P=0.024); the influencing factors and clinical stages of ONFH analyzed

14、by chi-square test have statistical significance are: age group(2 =38.135, P=0.000), marriage(2 =15.917, P=0.044), profession(2 =44.428, P=0.001）; the influencing factors and whether delayed analyzed by non-parametric rank sum test have statistical significance are: family social support(Z=1.991, P=

15、0.046), subjective support(Z=2.990, P=0.003), sickness impact(Z=2.221, P=0.026), treatment control(Z=-2.004, P=0.045),daily health behavior(Z=-2.668, P=0.008), physical health(Z=-2.483, P=0.013). .Conclusions 1. The current situation of young and middle-aged ONFH patients delay in seeking treatment

16、is very serious, over ninety percent patients seek for health care first time when they have approached the later period of illness. 2. The stage of ONFH is related with the time of patient delay, the longer time patients have delayed, the later period of illness will be. 3. The possible influencing factors of young and middle-aged ONFH patients delay in seeking treatment are: age, ma