老年骨科手术患者术前衰弱与术后1年内死亡的相关性  

Association between preoperative frailty and postoperative death within one year in elderly patients undergoing orthopedic surgery

作　　者：孙啸云 申玉英[3] 纪木火 徐建国 沈锦春 SUN Xiaoyun;SHEN Yuying;JI Muhuo;XU Jianguo;SHEN Jinchun(Department of Anesthesiology,Women's Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]东部战区总医院麻醉科,南京市210004 [2]南京医科大学附属妇产医院,南京市妇幼保健院麻醉科 [3]南京医科大学附属南京第一医院全科医学科 [4]南京医科大学第二附属医院麻醉科

出　　处：《临床麻醉学杂志》2022年第4期395-399,共5页Journal of Clinical Anesthesiology

基　　金：南京医科大学科技发展基金(NMUB2020130);军队医学科技青年培育计划(20QNPY077)。

摘　　要：目的探讨老年患者择期骨科手术后1年内死亡的危险因素,探究衰弱与术后1年内死亡的相关性。方法选择2018年12月至2019年6月接受择期骨科手术老年患者313例,男94例,女219例,年龄≥65岁,ASAⅠ—Ⅳ级。收集并记录性别、年龄、BMI、ASA分级、受教育年限以及术前、术中指标,采用埃德蒙顿衰弱量表(EFS)评估患者术前衰弱程度,术后1年通过电话进行随访。根据术后1年内是否死亡将患者分为两组:生存组和死亡组。采用单因素分析和多因素Logistic回归分析筛选术后1年内死亡的独立危险因素,通过受试者工作特征(ROC)曲线分析EFS对术后1年内死亡的预测效能。结果24例(7.7%)患者在术后1年内死亡。死亡组年龄、ASA分级、EFS、查尔森合并症指数(CCI)、卡茨指数(Katz ADL)、功能活动问卷(FAQ)评分、血糖、C反应蛋白、白细胞介素-6和术中失血量均明显高于生存组(P<0.05),BMI、简易精神状态评价量表(MMSE)和白蛋白均明显低于生存组(P<0.05)。多因素Logistic回归分析显示,EFS(每增加1分,OR=1.404,95%CI 1.169~1.685)是术后1年内死亡的独立危险因素之一。EFS预测术后1年内死亡的ROC曲线下面积(AUC)为0.826(95%CI 0.744~0.908,P<0.001)。结论衰弱评分增加与老年患者骨科术后1年内死亡呈正相关,为老年衰弱患者提供围术期干预指导,有利于改善患者预后。Objective To analyze the risk factors of death within one year after elective orthopedic surgery in elderly patients,and to study the association between frailty and 1-year death after surgery.Methods A total of 313 patients,94 males and 219 females,aged≥65 years,ASA physical statusⅠ-Ⅳ,underwent elective orthopedic surgery from December 2018 to June 2019 were selected.Preoperative and intraoperative indicators,gender,age,BMI,ASA physical status,and years of education were collected and recorded.Preoperative frail degree of each patient was assessed using the Edmonton frail scale(EFS).One-year postoperative follow-up was conducted by telephone.The patients were divided into two groups according to whether they died within 1 year after surgery:survival group and death group.Univariate analysis and multivariate Logistic regression were used to identify independent risk factors of 1-year mortality after surgery,and the predictive efficacy of EFS on 1-year mortality after surgery was analyzed using receiver operating characteristic(ROC)curve.Results Twenty-four patients(7.7%)died during the 1-year postopenative follow-up.Univariate analysis suggested that age,ASA physical status,EFS,Charlson comorbidity index(CCI),Katz index of independence in activities of daily living(Katz ADL),functional activities questionnaire(FAQ),blood glucose,C-reactive protein,interleukin-6 and intraoperative blood loss in death group were significantly higher than those in survival group.BMI,mini-mental state examination(MMSE)and albumin in death group were significantly lower than those in survival group(P<0.05).Multivariate Logistic regression analysis showed that EFS(each additional score,OR=1.404,95%CI 1.169-1.685)was an independent risk factor of increased 1-year postoperative death.The area under ROC curve(AUC)for EFS to predict 1-year postoperative mortality was 0.826(95%CI 0.744-0.908,P<0.001).Conclusion The increased frailty scores are associated with 1-year death in elderly patients after elective orthopedic surgery.Preoperat

关 键 词：老年 衰弱 骨科手术 围术期 

分 类 号：R614[医药卫生—麻醉学]