中青年股骨头坏死患者延迟就医行为影响因素分析

中青年股骨头坏死患者延迟就医行为影响因素分析第1页共32页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500~750万人，每年新发病例有15~20万[1]。发病也呈年轻化趋势，疾病人群以30~50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.研究对象的延迟情况从2天到长达七年不等，平均为83.4±95.5天（11.9±13.6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%，Ⅰ期占6.6%，Ⅱ期占42.5%，Ⅲ期占34.9%，Ⅳ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统计学意义的有：年龄分组（=38.135,P=0.000)、婚姻（=15.917，P=0.044）、职业（=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，中青年股骨头坏死患者延迟就医行为影响因素分析第2页共32页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，影响因素中青年股骨头坏死患者延迟就医行为影响因素分析第3页共32页STUDYONTHEINFLUENCINGFACTORSOFYOUNGANDMIDDLE-AGEDONFHPATIENTS’DELAYINSEEKINGTREATMENTABSTRACTBackgroundONFH(OsteonecrosisOfTheFemoralHead)isacommonorthopedicdisease.DuetotheunclearnessofONFH’setiologyandpathogenesis,ONFHpatientsoftenseekmedicaltreatmentuntiltheyhaveapproachedthelaterperiodofillness,whichseverelyimpairtheirclinicalresultsoftreatmentandlivingqualities.Accordingtosomerelatedtentativedata,thereareabout5~7.5millionpatientssufferedONFHinneedofmedicalcare.Andthereareanestimated150~200thousandcasesofONFHannually.Inrecentyears,theprevalenceoftheONFHtendstobeyounger,whichisinthe30~50yearrange.Meanwhile,therearenodomesticandinternationalresearchabouttheinfluencingfactorsofONFHpatientsdelayinseekingtreatmentatthisstage.ObjectiveToexploretheinfluencingfactorsofyoungandmiddle-agedONFHpatients’delayinseekingtreatment.Analyzingthepossibleinfluencingfactorsfromdemographicinformation,clinicaldata,socialfamilysupportsystems,selfefficacyandqualityoflife.Andexploringthedegreeofvariousfactorsandthedifferenceamongeachdiseasestage.MethodUsingbasicinformationquestionnaire,diseasesituationquestionnaire,BriefIllnessPerceptionQuestionnaire(BriefIPQ),Self-EfficacyforManagingChronicDisease6-ItemScale(SEMCD-6)andShortForm12HealthSurvey(SF12-V2)toinvestigate121patientswhoaccordwiththeinclusivecriteria.Theobjectsofinvestigationareselectedbyconvenientsampling.And106ofthemarevalidquestionnaires.ThedataisdoublecheckedandinputintoSPSS20.0andrechecked.Themeasurementdataisrepresentedintheformofmeanandstandarddeviation,theenumerationdataisrepresentedintheformofcasesnumber.Analyzingthepossibleinfluencingfactorsbycorrelationanalysisandnon-parametrictest.中青年股骨头坏死患者延迟就医行为影响因素分析第4页共32页Results1.Theelapsedtimefromsymptomdiscoverytotheinitialseekingforamedicalconsultationrangedfrom2daysto7years,2.TheratioofONFHclinicalstagesof0,Ⅰ,Ⅱ,Ⅲ,Ⅳis0.9%,6.6%,42.5%,34.9%,13.2%.3.ThereisapositivecorrelationbetweentheelapsedtimeandtheclinicalstageofONFH(r=0.469,P=0.000).4.Theinfluencingfactorsandelapsedtimeanalyzedbyspearmanrankcorrelationhavestatisticalsignificanceare:education(r=0.026,P=0.034),agegroup(r=0.315,P=0.001),illnessperception(r=-0.191,P=0.05),emotionalimpact(r=0.283,P=0.003),activitylimitation(r=-0.220,P=0.024);theinfluencingfactorsandclinicalstagesofONFHanalyzedbychi-squaretesthavestatisticalsignificanceare:agegroup(=38.135,P=0.000),marriage(=15.917,P=0.044),profession(=44.428,P=0.001）;theinfluencingfactorsandwhetherdelayedanalyzedbynon-parametricranksumtesthavestatisticalsignificanceare:familysocialsupport(Z=1.991,P=0.046),subjectivesupport(Z=2.990,P=0.003),sicknessimpact(Z=2.221,P=0.026),treatmentcontrol(Z=-2.004,P=0.045),dailyhealthbehavior(Z=-2.668,P=0.008),physicalhealth(Z=-2.483,P=0.013)..Conclusions1.Thecurrentsituationofyoungandmiddle-agedONFHpatients’delayinseekingtreatmentisveryserious,overninetypercentpatientsseekforhealthcarefirsttimewhentheyhaveapproachedthelaterperiodofillness.2.ThestageofONFHisrelatedwiththetimeofpatientdelay,thelongertimepatientshavedelayed,thelaterperiodofillnesswillbe.3.Thepossibleinfluencingfactorsofyoungandmiddle-agedONFHpatients’delayinseekingtreatmentare:age,marriage,education,illnessperception,emotion,socialfamilysupportsystems,dailyhealthbehaviorandphysicalhealth.Keywords:ONFH,patientdelay,influencefactors中青年股骨头坏死患者延迟就医行为影响因素分析第5页共32页目录第一章绪论..................................................................71.1引言...................................................................71.2股骨头坏死就医行为现状.................................................71.3延迟就医的影响因素.....................................................7第二章对象和方法.............................................