老年急症患者的InterRAI急性病照护综合评估  

The interRAI acute care for comprehensive geriatric assessment in elderly emergency patients

作　　者：朱海兰[1] 孟繁森 林云娟 石海燕[1] 王丽媛[1] 谢海雁[2] 裴晓梅[3] 王刚石[1] Zhu Hailan;Meng Fansen;Lin Yunjuan;Shi Haiyan;Wang Liyuan;Xie Haiyan;Pei Xiaomei;Wang Gangshi(Department of Gastroenterology,the Second Medteal Center of PLA General Hospital,Beijing 100853,China;Department of Cadre Health,Peking Union Medical College Hospital,Beijing 100010,China;Department of Sociology,Tsinghua University,Beijing 100084,China)

机构地区：[1]解放军总医院第二医学中心消化内科,北京100853 [2]北京协和医院干部保健科,100010 [3]清华大学社会学系,北京100084

出　　处：《中华老年医学杂志》2020年第11期1292-1296,共5页Chinese Journal of Geriatrics

基　　金：军队保健课题(18BJZ22)。

摘　　要：目的利用InterRAI急性病照护-老年综合评估系统(interRAI AC-CGA)研究老年急症患者功能状态的动态变化,分析评估结果是否有助于临床判断。方法选取2017年10月至2018年3月于解放军总医院急诊住院治疗的老年患者(年龄A60岁),使用interRAI AC-CGA评估量表分别在人院时(第1天)、入院后第7天、第28天进行数据采集,用interRAI AC-CGA评估标尺、老年人综合征和不良结局风险判断指标对采集的数据进行分析,研究患者入院时及入院后各种功能状态的变化,并探讨入院时的功能状态与治疗结局(出院)之间的关系。结果共评估患者34例,男性26例、女性8例,年龄60〜101(84.2±10.1)岁。在入院时和住院过程中,患者的多种功能状态均出现了异常,其中日常生活活动能力和工具性日常生活活动能力的下降较为明显。与第1天的评估结果比较,经过治疗后第7天和第28天各种功能异常的发生率明显下降,其中短暂抑郁、疼痛、跌倒等功能出现明显改善(χ^2=6.298、6.027、7.766,P=0.043,0.049,0.021).第28天评估后,出院16例、继续住院18例(包括死亡2例),出院组大部分指标的异常率均低于继续住院组,其中出院组.的交流和跌倒异常率显著低于继续住院组,差异有统计学意义(χ^=6.349、5.443,P=0.019、0.030)。年龄(》85岁)对出院无影响,超高龄组(≥85岁)的出院率(8/20,40.0%)与普通老年组(60〜84岁)(8/14、57.1%)比较差异无统计学意义(χ^2=0.971,P=0.324)。结论InterRAI AC-CGA可以系统并动态地评估老年急症患者的功能状态变化,入院时的功能状态与患者的预后(出院)相关。Objective To evaluate dynamic changes of functional status in elderly emergency inpatients by using the interRAI Acute Care for Comprehensive Geriatric Assessment(interRAI AC-CGA),and to analyze whether assessment results are helpful for clinical decision-making.Methods Elderly patients(aged 60 years and older)who were hospitalized in the Acute Care Unit of PLA General Hospital from October 2017 to March 2018 were included.Each patient received the interRAI AC-CGA instrument-based assessment at admission(day 1),on day 7 and day 28 after admission.Analysis of collected data was conducted using interRAI AC-CGA scales,geriatric syndrome screening and risk identification of adverse outcomes,in order to examine dynamic changes of functional status in patients at and after admission and to explore the relationship between functional status at admission and outcomes(at discharge).Results Thirty-four patients were evaluated,including 26 males and 8 females,aged from 60 to 101 years,with a mean age o£(84.2±10.1)years.Patients had a variety of functional abnormalities at admission and during hospitalization,in which the ability to perform activities of daily living(ADL)and instrumental activities of daily living(IADL)decreased significantly.Compared with evaluation results on day 1,the incidences of functional abnormalities on day 7 and day 28 declined,and there was improvement in transient depression,pain and falls(χ^2=6.298,6.027 and 7.766,P=0.043,0.049 and 0.021).After evaluation on day 28,16 patients were discharged and 18 remained hospitalized(including 2 deaths).The rate for most abnormality was lower in the discharge group than in the continued hospitalization group,and the rates for abnormal communication and falls were lower in the discharge group than in the continued hospitalization group(χ^2=6.349 and 5.443,P=0.019 and 0.030).Age(≥85 years old)had no effect on discharge.There was no significant difference in hospital discharge rate between the advanced age group(≥85 years old)and the elderly group(60-84

关 键 词：急症照护 功能状态 老年综合评估 

分 类 号：R459.7[医药卫生—急诊医学]