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研究生:黃乙震
研究生(外文):Yi-Zhen Huang
論文名稱:台灣成年人握力常模之建立與食道癌術後指標
論文名稱(外文):Role of outcome predictor in esophageal cancer following esophagectomy and Norm establishment of Hand-Grip Streagth in Taiwan adults.
指導教授:張合
指導教授(外文):Ho Chang
口試委員:陳治豪江毅成鍾清枝
口試委員(外文):Chih-Hao ChenYi-Chen ChiangTsing-Tshih Tsung
口試日期:2012-07-17
學位類別:碩士
校院名稱:國立臺北科技大學
系所名稱:製造科技研究所
學門:工程學門
學類:機械工程學類
論文種類:學術論文
論文出版年:2012
畢業學年度:100
語文別:中文
論文頁數:70
中文關鍵詞:握力常模食道癌術後指標
外文關鍵詞:handgripnormesophageal canceroutcome predictor
相關次數:
  • 被引用被引用:3
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  • 評分評分:
  • 下載下載:33
  • 收藏至我的研究室書目清單書目收藏:2
握力(Handgrip Strength,HGS)是指特定條件下單手緊握握力器產生的力量總和,其力量主要由前臂外侧肌群和手内在肌群的共同收缩活動而產生,一般以公斤為單位顯示。本研究的第一部分目的在於由機械式握力測定計,利用抓握動作測定到單一最大抓握力量。結果,得到在客觀條件下所測得之即時握力值,經評估以性別及慣用手分類下,其年齡、體重、身高的分佈值R^2 (0.21、0.39、0.17)及P值(P<0.001)皆達到一致的顯著水準,在相關性分析中,相關係數(-0.459、0.421、0.631)跟P值皆呈現高度複相關且達到顯著水準。這也表示,不管是年齡、身高、體重皆與握力產生影響,且有不錯的預測價值。這種趨勢與國外文獻所報告之文獻並無顯著不同,這些都是建構常模的重點之一。第二部分,針對特定族群”食道癌患者”,以手握力是作為一個指標,以評估病人術後的生理狀態。其結果,在受試者ROC曲線分析中,可發現其發病率至少為25公斤還有22公斤的死亡率。因此,可將定義握力25公斤為一基準,若握力超過25公斤,死亡率有72.41﹪與84.37﹪的併發症機率;握力低於22公斤,死亡率則有75﹪和79.25﹪併發症。在食道癌研究中,握力分析有不錯預測的結果,也有必要將握力測定,做為即將接受食道癌治療與重建患者臨床評價工具。此研究的第三部份在將握力測定作為適合的臨床工具下,以鑒於方便資料蒐集,建構一套可攜帶的數位式電子儀器,其施測與計分方式均由電腦程式執行,可提供客觀的測驗資料。由本實驗所得到的結果,可支持臨床治療對於手握力大小扮演相對重要的角色。並利用此結果提供醫療人員在臨床照護及治療之基礎,且幫助術後患者免於惡化的可能性。

This research aims to develop thenorm of adult hand-grip strength in Taiwan. Its role of clinical applications were investigated in the study. Hand-grip strength (HGS) is the maximal force that generated by holding the grip dynamometer with greatest effort in the hand under standard position. The force is generated by thecombination of both forearm and hand muscles. The results are read in either kg or pounds. HGS reflects the strength of forearm and hand muscle. We evaluated the grip strength difference in patients grouped according to each clinical variables, incling gender, handedness, the distribution values R2(0.21、0.39、0.17) of age, weight, and height and assessed if it reachedstastistical significant level. In the second part, the HGS was viewed as an indicator to eveluate the physiological state of patients with esophageal cancer after surgery. The results of ROC curve analysis showed that the complication rate will increaed if the HGS less than 25 kg. The mortality rate will increased of the HGS less than 22kg. Therefore, 25 kg of HGS was defined as a cut-of-value. The mortality is 72.41% and the complication rate is 84.37% if the HGS is less than 25kg. The mortality is 75% and the complication rate is 79.25% if the HGS is less than 22kg.In the third part of this research, HGS determination was treated as a clinical tool for the appropriate. The portable digital electronic devices was constructed and applied to HGS measurement. The measurement and scoring method were implemented by computer program and the data were recorded objectively.The results of experiments showed that the HGS plays an important role in .clinical evaluation. The results provide a basis of clinical care and treatment for medical staff. Additionally, it may has role in preoperative evaluation and may relate to postoperative complication and mortality rate.

目錄
摘要 I
ABSTRACT III
誌謝 V
目錄 VI
表目錄 VIII
圖目錄 X
第一章 緒論 1
1.1 前言 1
1.2 研究動機與目的 4
1.3 本文結構 5
第二章 文獻回顧與基本原理 7
2.1 老化生理機制 7
2.1.1 衰弱指標(Fried Frailty Index) 7
2.1.2 肌少症(Sarcopenia) 7
2.1.3 肌纖維(Sarcomere)退化 8
2.2 握力的意義 9
2.2.1 良好的握力是手功能及生活自理能力維持的基礎 9
2.2.2 握力是體質測試與疾病預測重要指標 9
2.3 握力值及其影響因素 11
2.3.1 握力值 11
2.3.2 握力值的影響因素 11
2.3.3 老年握力的正常參考值 17
2.4. 重量感測電路 19
2.4.1 惠斯登式電橋(Wheatstone Bridge) 19
2.4.2 應變規(Stain gage) 20
2.4.3 放大器電路 24
第三章 研究架構 27
3.1 研究方法 27
3.1.1 握力的測量工具 27
3.1.2 握力的測量方法 28
3.2 研究樣本 29
3.2.1 研究進行時間 30
3.2.2 選擇統計方法 30
3.3 資料分析統計與呈現方法 32
3.4 數位量測系統 33
第四章 研究結果與討論 34
4.1 握力常模建立與適用性 34
4.1.1 預測握力與變項因子的線性關係 38
4.1.2 性別與慣用手相關因子對握力平均數的差異 45
4.1.3 同一族群三項變項因子與握力的假設 46
4.1.4 各項因子的相關性 50
4.1.5 左右手握力的迴歸關係 51
4.2 病例組-食道癌縱貫性研究 54
4.3 討論 60
第五章 結論 62
參考文獻 64
附錄 70

表目錄
表 2. 1 各國家的體適能項目 10
表 2. 2 男性年齡增加的握力變化[13]-[16] 14
表 2. 3 女性年齡增加的握力變化[13]-[16] 15
表 2. 4 75歲以上老年男性左右手握力值[35] 18
表 2. 5 75歲以上老年男性左右手握力值[35] 18
表 2. 6 接腳介紹 26
表 3. 1 研究樣本統計表 29
表 3. 2 統計方法的分類 31
表 4. 1 描述性統計總表 34
表 4. 2 測量項目統計圖 37
表 4. 3平均握力統計總表 38
表 4. 4 迴歸統計表 39
表 4. 5 迴歸統計圖 41
表 4. 7 迴歸統計圖 43
表 4. 8 變項因子的迴歸係數總表 44
表 4. 9 左右手握力差異表 45
表 4. 10 獨立樣本檢定表 46
表 4. 11 誤差變異量的 Levene 檢定等式(a) 47
表 4. 12 受試者間效應項的檢定 47
表 4. 13 對比結果表 (K矩陣) 48
表 4. 14 檢定結果 48
表 4. 15 係數表 52
表 4. 16 依觀察值順序診斷表 52
表 4. 17 食道癌握力統計圖 54
表 4. 18 以握力區分類別總表 56
























圖目錄
圖 1. 1 年齡增加的握力改變[11]-[14] 3
圖 1. 2 實驗流程圖 6
圖 2. 2 年齡與肌肉質量散佈圖[19] 12
圖 2. 3 各年齡層男女握力的差異[11]-[14] 13
圖 2. 5 惠斯登式電路[50] 19
圖 2. 6 電阻元件[49] 21
圖 2. 7 應變規之方向性[49] 22
圖 2. 8 標準荷重元(Load Cell)[49] 23
圖 2. 9 典型運算放大器[51] 24
圖 2. 10 運算放大器 LM471[51] 25
圖 2. 11 運算放大器接腳圖[51] 25
圖 2. 12 放大器細部圖-虛接地[51] 26
圖 3. 1 (a) Jamar氣壓式握力器 (b) Yarzan彈簧式握力器 27
圖 3. 2 數位量測系統示意圖 33
圖 4. 1 年齡與握力散佈圖 39
圖 4. 2 年齡與握力散佈圖(a)男性(b)女性 40
圖 4. 3 身高與握力散佈圖 41
圖 4. 4 年齡與握力散佈圖(a)男性(b)女性 42
圖 4. 5 體重與握力散佈圖 43
圖 4. 6 體重與握力散佈圖(a)男性(b)女性 44
圖 4. 7 殘差散佈圖 49
圖 4. 8 殘差散佈圖 49
圖 4. 9 Rgrip&Lgrip 散佈圖 51
圖 4. 10 剔除後殘差圖 53
圖 4. 11 剔除前殘差圖 53
圖 4. 12 併發症與死亡率比較百分比圖 55
圖 4. 13 併發症機率勝算比圖 57
圖 4. 14 六個月死亡率勝算比圖 57
圖 4. 15 握力與年齡散佈圖 58
圖 4. 16 平均握力盒裝圖 59











































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