住院老年患者衰弱评估及对术后并发症预测效能的比较  

Comparison of Frailty Assessment Methods for Predicting Postoperative Complications in Hospitalized Elderly Patients

作　　者：夏宇晓 冯秀丽[1] 郭玮 钟善娇 丁榆[1] 董嫚嫚 杨学伟[1] 周英 XIA Yuxiao;FENG Xiuli;GUO Wei;ZHONG Shanjiao;DING Yu;DONG Manman;YANG Xuewei;ZHOU Ying(Dept.of General Surgery,The 2nd Affiliated Hospital of Guangzhou Medical University,Guangzhou Guangdong 510260;School of Nursing,Guangzhou Medical University,Guangzhou Guangdong 510030,China)

机构地区：[1]广州医科大学附属第二医院普通外科,广东广州510260 [2]广州医科大学护理学院,广东广州510030

出　　处：《昆明医科大学学报》2022年第7期121-127,共7页Journal of Kunming Medical University

基　　金：广东省普通高校基础研究与应用基础研究重点项目(2018KZDXM055);广州医科大学附属第二医院护理科研基金项目(A202009)。

摘　　要：目的应用FP(frailty phenotype,FP)、FI-CD(frailty index of accumulative deficits,FI-CD)、Frail Scale、TFI(tilburg frailty indicator,TFI)4种衰弱评估方法对胃肠外科住院老年患者进行衰弱评估,并对其预测术后并发症的能力进行比较。方法采用队列研究方法,选取广州市某医院2个院区胃肠外科手术老年患者进行资料收集,包括一般资料、FP、FI-CD、Frail Scale、TFI、手术时间、出血量、住院期间发生的并发症以及出院30 d内发生的并发症资料等。计算受试者工作特征曲线(receiver operating characteristic,ROC)和曲线下面积(area under the roc curve,AUC),比较FP、FI-CD、Frail Scale、TFI 4种衰弱评估量表预测术后并发症的能力。结果共纳入294位患者资料,21例失访,最终收集到完整资料273例,年龄为60~88(69.49±6.90)岁。采用FP、FI-CD、Frail Scale、TFI评估检出衰弱的比例分别为30.4%、24.5%、28.6%、26.4%。经卡方检验,FP、FI-CD与Frail Scale(FS)、TFI评估结果两两比较kappa值分别为0.52、0.60、0.47、0.65、0.54、0.58(P<0.001),一致性较弱。FP、FI-CD、Frail Scale、TFI预测术后并发症的AUC分别为0.896[95%CI(0.784,0.929)]、0.767[95%CI(0.706,0.829)]、0.799[95%CI(0.742,0.857)]、0.745[95%CI(0.683,0.808)],(均P<0.001)。结论不同衰弱评估工具对衰弱的检出率差异较大,在临床工作中选取衰弱评估量表时需要慎重。FP、FI-CD、FS、TFI对术后并发症的AUC分别为0.836、0.767、0.799、0.745,FP预测术后并发症的能力强于其他3种衰弱评估工具。Objective To evaluate frailty of surgical elderly hospitalized patients by four kinds of frailty assessment tools,FP(frailty phenotype,FP),FI-CD(frailty index of accumulative deficits,FI-CD),Frail Scale,and TFI(tilburg frailty indicator,TFI),and to compare their ability to predict postoperative complications.Methods A cohort study method was used to select elderly patients undergoing surgical operations in Guangzhou hospitals for data collection,including general information,FP,FI-CD,Frail Scale,TFI,operation time,blood loss,complications during hospitalization,and those occurring within 30 days of discharge Complication information,etc.We calculated the receiver operating characteristic curve(ROC)and area under the ROC curve(AUC),and compared the ability of FP,FI-CD,Frail Scale,and TFI to predict postoperative complications.Results A total of 294 patients were included,21 cases were lost to follow-up,and 273 patients with complete data were finally collected,aged 60-88(69.49±6.90)years old.The percentages of frailty detected by FP,FICD,Frail Scale,and TFI were 30.4%,24.5%,28.6%,and 26.4%,respectively.After chi-square test,the kappa values of FP,FI-CD and Frail Scale(FS)and TFI evaluation results were 0.52,0.60,0.47,0.65,0.54,0.58,respectively(P<0.001),and the consistency was weak.The AUC of FP,FI-CD,Frail Scale,and TFI predicting postoperative complications were 0.896[95%CI(0.784,0.929)],0.767[95%CI(0.706,0.829)],0.799[95%CI(0.742),respectively,(0.857)],0.745[95%CI(0.683,0.808)],(all P<0.05).Conclusions Different frailty assessment tools have great differences in the detection rate of frailty,and caution should be exercised when selecting frailty assessment methods in clinical work.AUC for FP,FI-CD,FS,and TFI for postoperative complications are 0.836,0.767,0.799,and 0.745,respectively.The ability of FP to predict postoperative complications is better than the other three assessment tools.

关 键 词：老年人 衰弱评估 并发症 衰弱 

分 类 号：R473.73[医药卫生—护理学]