老年骨科大手术患者术前衰弱风险评估模型的构建与评价  

Development and validation of a preoperative frailty risk assessment model for elderly patients undergoing major orthopedic surgery

作　　者：胡雁真 王蕾 曹志丹 王燕[2] 陈晓英[3] Hu Yanzhen;Wang Lei;Cao Zhidan;Wang Yan;Chen Xiaoying(School of Graduate,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)

机构地区：[1]天津中医药大学研究生院,天津301617 [2]天津中医药大学护理学院 [3]天津医院创伤骨科

出　　处：《护理学杂志》2020年第9期32-36,共5页Journal of Nursing Science

摘　　要：目的探讨老年骨科大手术患者术前衰弱相关危险因素,构建风险评估模型,并预测其效能。方法选取拟行骨科大手术的老年患者384例,采用一般资料调查表、FRAIL衰弱量表、查尔斯共病评估表、运动耐量评估表、简版老年抑郁量表及微型营养评定简表进行调查,经二元Logistic回归分析确定风险评估模型,采用受试者工作特征曲线检验模型效果。结果骨科大手术老年患者术前衰弱发生率为50.5%;年龄≥80岁、记忆丧失与社会活动减少、营养不良、共病4个因素为骨科大手术老年患者术前衰弱的预测因素。模型的受试者工作特征曲线下面积为0.727,约登指数为0.422,灵敏度为0.722,特异度为0.700。结论骨科大手术老年患者衰弱发生率较高,高龄、记忆丧失与社会活动减少、营养不良及共病是术前衰弱的危险因素;模型预测效能较好,需进一步进行大样本的临床验证。Objective To explore the risk factors related to preoperative frailty in elderly patients undergoing major orthopedic surge-ry,to develop a risk assessment model and test its predictive validity.Methods A total of 384 elderly patients scheduled for major orthopedic surgery were investigated using a self-designed general information questionnaire,the FRAIL scale,Charlson Comorbidity Index,Exercise Tolerance Evaluation,Geriatric Depression Scale-15 and Short-form Mini-Nutritional Assessment.Then logistic regression analysis was employed to determine the risk factors,and the receiver operating characteristic(ROC)curve was used to test the model.Results The prevalence of preoperative frailty was 50.5%in elderly patients undergoing major orthopedic surgery.The risk factors included age greater than 80,memory loss and social activity reduction,malnutrition and presence of comorbidity.The area under the ROC curve of this model was 0.727,with the Youden index of 0.422,the sensitivity of 0.722,and specificity of 0.700.Conclusion Preoperative frailty was common in elderly patients undergoing major orthopedic surgery;advanced age,memory loss and social activity reduction,malnutrition and comorbidity were risk factors.The predictive validity of the model was satisfactory,but large samples are required to validate the model.

关 键 词：老年人 骨科手术 髋关节置换 膝关节置换 衰弱 风险预测 模型 营养不良 抑郁 共病 

分 类 号：R473.6[医药卫生—护理学]