【作者】 肖雁飞；

【导师】 黄春长； 葛淼；

【作者基本信息】 陕西师范大学 ， 自然地理学， 2004， 硕士

【摘要】 健康人动脉血氧分压参考值是健康人血气分析参考值的一个重要指标，而健康人血气分析参考值是医学参考值的一个重要指标。动脉血氧分压参考值是对疾病进行诊断和防治的基本依据，每个地区、每个医院都必须建立一套参考值标准。但由于各地地理环境不同，测定的仪器、对象、方法各异，使得各地区动脉血氧分压参考值不一致，严重影响了临床诊断的准确性。因此，开展动脉血氧分压参考值地理分布规律的研究具有重要意义。 本论文以国家自然科学基金资助项目“中国人血气分析参考值与地理因素的关系”为依托，以医学地理学理论、血气分析理论、自然地理学理论和数理统计原理为依据，运用计算机手段，主要是SPSS 11.0统计软件、Excel和Access数据处理软件、地理信息系统制图软件（MapInfo），对动脉血氧分压参考值与地理因素关系进行了研究。通过探讨动脉血氧分压参考值与选取地理因素指标的相关分析、回归分析、回归模型检验，研究了动脉血氧分压参考值的地理分布规律；运用线性回归分析和非线性回归分析建立了动脉血氧分压参考值与地理因素的回归模型，对测算动脉血氧分压参考值提供了一种简便实用的方法。 本论文共分为七个部分。第一部分为研究背景。解释了论文课题来源；阐述学科国内外研究现状及其选题意义，并简单介绍了血气分析基本概念及酸碱平衡理论，重点解释了动脉血氧分压（PaO₂）的定义和临床意义；提出了本论文研究方法和研究成果的创新之处。第二部分简单介绍了动脉血氧分压参考值的医学背景。主要是介绍了动脉血氧分压参考值的测定方法、仪器选择和动脉血氧分压参考值资料的选取，并用MapInfo软件把所选取的动脉血氧分压参考值制成地区分布图。第三部分介绍了区域地理特征及地理指标选取。描述了中国研究区的自然地理特征，并用MapInfo制图直观的表示：选取十个地形和气候指标，简单介绍各地理指标的意义，并把各地理指标值和动脉血氧分压参考值做成表格形式。第四部分为本论文的主体之一，主要是对动脉血氧分压参考值与地理因素的相关分析。论文把数据分为18～40岁中青年和40～65岁中老年两个年龄段，依次对中青年和中老年进行复相关分析、单相关分析，最后得出动脉血氧分压参考值与所选的地理因素相关性显著，尤其是与海拔高度的相关系数最大，相关性最为显著。第五部分为本论文的主体之二，是在相关分析的基础上，对动脉血氧分压参考值与地理因素进行回归分析，也是分为18～40岁中青年和40～65岁中老年两个年龄段，依次进行一元线性回归分析、多元线性回归分析、逐步回归分析、非线性回归分析，得出一系列的回归方程，再通过F检验和拟合度（即决定系数对）的比较，得出两个最优的模型: ①、18一40岁中青年健康成年人动脉血氧分压参考值预测模型:YI=12.5447*e一o删IX，，F二332.9，P=0.000<0.01 Yl的预测区间是:〔Yl一1.59，Yl+1 .59]，1.59为1.%个剩余标准差。②、40一65岁中老年健康成年人动脉血氧分压参考值预测模型:YZ二10.429一0.0012玲0.025 36 X7，F=240.626，P=0，000(0.01， YZ的预测区间是:〔YZ一1.22，YZ+1.221，1.22为1.%个剩余标准差。 第六部分是根据自然区划原则，把中国分为八个区，选择有代表.的地点估算和验证各区动脉血氧分压参考值，并用Maplnfo制成动脉血氧分压参考值的地理分区图。第七部分为全文的结论。通过相关分析，发现海拔高度是影响健康成年人的动脉血氧分压参考值最主要的因素，随着海拔高度的逐渐增大，空气逐渐稀薄，大气压逐渐减低，氧含量逐渐减少，机体吸入氧气分压低，机体为了适应缺氧的环境，使得体内的动脉血氧分压降低，因而其参考值也低于平原富氧地区，导致了健康成年人的动脉血氧分压参考值随海拔高度的升高而逐渐降低。通过回归分析、F检验和对决定系数的比较，得出动脉血氧分压参考值与地理因素的两个最优模型，并利用此模型估算和验证各地区的动脉血氧分压参考值。通过单因素方差检验，发现模型估算出的预测值和实测值高度一致，说明这两个方程是可以有效的预测某一地区的动脉血氧分压参考值，从而为从地理因素着手计算动脉血氧分压参考值提供了一种简便实用的方法。本论文的主要研究成果是回归模型的建立，应用此模型可以方便的估算和验证中国任何地区的动脉血氧分压参考值。本论文的研究方法和研究成果将丰富医学地理学的内容。 本论文的创新之处在于对动脉血氧分压参考值与地理因素定量化研究。虽然前有少数医学报道涉及到动脉血氧分压参考值与地理因素的关系研究，但也只是定性描述，或者只选择海拔高度一个指标、利用海拔系数预测和估算局部地区的动脉血氧分压参考值，像本论文这样对动脉血氧分压参考值与地理因素进行专题化定量化研究，从整个地理环境着手，整体的研究中国这一大的区域，国内外还未见有报道。更多还原

【Abstract】 Reference value of PaO2 of the healthy is an important indicator of blood-gas analysis, yet the reference value of is an important indicator of reference value of medicine. Every region and hospital must have a set of standards of reference value because PaO2 is the basis for diagnosing and treating disease. However, the reference value of PaO2 of each region is not unanimous own to the difference of geographical environment, instruments, objects, methods to determine. It also effects the accuracy of diagnose. Therefore, it is important to study the law of geographical distribution of the reference value of PaO2.The thesis relied on the nature science fund and had the basis of the theories of medical geography, blood-gas analysis, physical geography and mathematical statistics, made use of computer methods, such as SPSS 11.0, Excel, Access, GIS. By analyzing the correlation and regression between the reference value of PaO2 and geographical factors, the thesis had some regression equations to determine the reference value of PaO2.The thesis has seven parts.The first part was the preface, including the source of the topic, the meaning and present situation of study in domestic or international and the point of innovation. The second part introduced the basic conception of blood-gas analysis, explained especially the definition, clinical meaning, methods to determine and selection of instruments of PaO2. And the following part explained the feature of Chinese physical geography and manifested on map by Maplnfo software. The fourth part is one of the major parts. It mainly made correlations between reference value of PaO2and geographical factors. The thesis divided the data by two age periods--18 to 40years old and 40 to 65 years old, had single and multiple correlations respectively. It was found that the correlation between geographical factors and the reference value ofPaO2 were high significant, especially the altitude.As the followed part was another major one, had regressions between the above-mentioned twos by two age periods based on correlations, such as single linear, multiple linear, stepwise and curve regressions. Therefore, a series of regression equations were given out, and selected two most effective equations through comparing F test to the degree of coincidence:(1), Y1=12.8447*e-0.0001X1 1.59, F=332.9, P=0.000 <0. 01. (2), Y2=10.429-0.00123X1+0.02536X7 1.22, F=240.626, P=0.000 <0. 01. The sixth part had divided eight regions in China, then estimated and tested the reference value of PaO2 of each region by selecting typical places and made map by Maplnfo. Finally, the seventh part was the summary of the thesis.The innovation of the thesis lies in making quantitative study between the reference value of PaOa and geographical factors. Since a few medical reports had involved studying the relationship between the reference value of PaO2 and geographical factors, but they only made qualitative study or selected the altitude coefficient to estimated the reference value of PaO2 in a few region of China. There are no reports in domestic and international that made special and quantitative study of the twos from the whole geographical environment and the whole China region like the thesis. The main research results are regression equations and can easily estimate the reference value of PaO2 each region in China by using these equations. And the research methods and results of the thesis will be abundant to the contents of medical geography.更多还原