衰弱评分在预测老年患者腹部手术后早期谵妄发生价值的研究  

The prognostic value study of frailty for early postoperative delirium in older patients undergoing abdominal surgery

作　　者：刘殿刚[1] 宿士智[2] 楚长彪[3] 宋海庆[3] 陈宏[1] 李非[1] 

机构地区：[1]首都医科大学宣武医院普外科,北京100053 [2]首都医科大学北京市大兴区人民医院普外科,北京102600 [3]首都医科大学宣武医院神经内科,北京100053

出　　处：《中国医刊》2017年第3期51-54,共4页Chinese Journal of Medicine

基　　金：中国博士后科学基金资助项目(2012M510094);北京市215高层次卫生技术人才学术骨干项目(2015-3-066)

摘　　要：目的研究衰弱评分与行腹腔镜腹部手术的老年患者术后谵妄发生的关系,探讨其预测价值。方法前瞻性观察2013年6月至2015年12月间,年龄大于60岁行腹腔镜胃肠肿瘤手术的患者,术前记录衰弱评分、日常生活活动能力(activities of daily living,ADL)、工具性日常生活活动能力(instrumental activities of daily living,IADL)及抑郁自评量表评分(self-rating depression scale,SDS)。分析衰弱评分与术后谵妄发生率关系,多元回归分析术后谵妄发生的相关危险因子。结果 123例患者年龄60~91岁,平均(73.58±6.23)岁,术后谵妄发生率与衰弱评分相关(衰弱43.4%vs轻度衰弱20.6%vs无衰弱2.8%,P<0.01),术前衰弱、ADL和SDS评分与术后谵妄发生有关。采用多元回归分析显示术前衰弱、ADL、IADL和SDS评分与术后谵妄发生相关。结论术前衰弱评分是预测术后谵妄发生的独立危险因素。Objective To determine the relationship between preoperative frailty and the occurrence of early postoperative delirium （POD） undergoing abdominal surgery in the older patients Method Patients 60 years or older undergoing abdominal surgery were enrolled. Frailty status also was measured preoperatively by Fried score. Independence in functional status was measured by the Activities of Daily Living （ADL） and Instrumental Activities of Daily Living （IADL）. Self-rating depression scales （SDS） was used to measure symptoms of depression. The incidence of POD was compared among the different frailty groups, a multilevel logistic regression model was used to explore factors associated with the risk of early postoperative delirium. Result One hundred and twenty three subjects （age from 60to 91, 73.58±6.23 years） were studied. Preoperative frailty was associated with increased postoperative delirium （frail 43.4% vs intermediately 20.6% vs no frail 2.8%, P〈 0.01） after abdominal surgery. Preoperative frailty score, ADL, and the SDS score were significantly associated with the development of POD. The multivariable logistic regression analysis showed that preoperative frailty score, ADL, IADL and SDS score were significantly associated with POD. Conclusion The preoperative frailty score may be used as a predictor of POD for the evaluation of elderly patients .

关 键 词：老年人 腹部手术 衰弱 术后谵妄 术后并发症 

分 类 号：R619[医药卫生—外科学]