老年患者静脉麻醉下消化内镜微创治疗术后早期恢复与衰弱的关系  

Relationship between early postoperative recovery and frailty after digestive endoscopy-assisted minimally invasive surgery under intravenous anesthesia in the elderly

作　　者：谢郭豪[1] 刘正律 周瑞 宋胜文 郑君刚[2] 黄长顺[2] 方向明[1] Xie Guohao;Liu Zhenglyu;Zhou Rui;Song Shengwen;Zheng Jungang;Huang Changshun;Fang Xiangming(Department of Anesthesiology,The First Affiliated Hospital,Zhejiang University,Hangzhou 310003,China;Department of Anesthesiology,Ningbo First Hospital,Ningbo 315010,China)

机构地区：[1]浙江大学医学院附属第一医院麻醉科,杭州310003 [2]宁波市第一医院麻醉科,宁波315010

出　　处：《中华麻醉学杂志》2022年第9期1035-1038,共4页Chinese Journal of Anesthesiology

基　　金：浙江省‘尖兵’‘领雁’研发攻关计划项目(2022C03163)。

摘　　要：目的评价老年患者静脉麻醉下消化内镜微创治疗术后早期恢复与衰弱的关系。方法以择期行静脉麻醉下消化内镜微创治疗的老年住院患者(年龄≥65周岁)为研究对象,记录患者停止丙泊酚给药至患者改良Aldrete评分≥9分的时间,以此作为早期恢复时间,根据术后早期恢复时间是否短于75%的患者将其分为术后早期恢复时间正常组和术后早期恢复时间延长组。采用衰弱表型方法进行衰弱评估(衰弱表型评分0~5分),衰弱表型评分≥3分时诊断为衰弱。记录患者年龄、性别、身高、体重、吸烟史、ASA分级、手术类型、基础MAP和HR。采用logistic回归分析法筛选老年患者静脉麻醉下消化内镜微创治疗术后早期恢复时间延长的危险因素。结果共纳入214例患者,术后早期恢复时间正常组169例,术后早期恢复时间延长组45例。与术后早期恢复时间正常组比较,术后早期恢复时间延长组衰弱、年龄、10年以上饮酒史、术前ASA分级和丙泊酚给药时间差异有统计学意义(P<0.05)。logistic回归分析结果显示:衰弱、年龄、ASA分级Ⅲ级和丙泊酚给药时间是老年患者静脉麻醉下内镜微创治疗术后早期恢复时间延长的独立危险因素(P<0.05)。结论衰弱、年龄、ASA分级Ⅲ级和丙泊酚给药时间是老年患者静脉麻醉下内镜微创治疗术后早期恢复时间延长的独立危险因素。Objective To evaluate the relationship between early postoperative recovery and frailty after digestive endoscopy-assisted minimally invasive surgery under intravenous anesthesia in the elderly.Methods This study retrospectively selected hospitalized patients,aged≥65 yr,scheduled for elective gastrointestinal endoscopic treatment.Early postoperative recovery time was defined as the period from the end of propofol administration to the achievement of a modified Aldrete score of 9.All the patients were divided into 2 groups according to whether the early recovery time after operation was less than 75%:normal early postoperative recovery time group and delayed early postoperative recovery time group.Frailty was assessed using the frailty phenotype(FP score 0-5),and the patient was diagnosed as frail(FP≥3)or non-frail(FP 0-2).The age,sex,height,weight,smoking history,American Society of Anesthesiologists(ASA)Physical Status classification,type of operation,and baseline mean arterial pressure and heart rate were recorded.Logistic regression analysis was used to identify the risk factors for delayed early postoperative recovery time after minimally invasive digestive endoscopy under intravenous anesthesia in elderly patients.Results A total of 214 patients were enrolled and divided into normal early postoperative recovery time group(n=169)and delayed early postoperative recovery time group(n=45).There were significant differences in frailty,age,drinking history of more than 10 yr,preoperative ASA Physical Status classification and propofol administration time between delayed early postoperative recovery time group and normal early postoperative recovery time group(P<0.05).The results of logistic regression analysis indicated that frailty,age,ASA Physical Status classificationⅢ,and propofol administration time were independent risk factors for the occurrence of delayed early postoperative recovery(P<0.05).Conclusions Frailty,age,ASA Physical Status classificationⅢand propofol administration time are independent

关 键 词：老年人 麻醉 静脉 最小侵入性外科手术 预后 衰弱 

分 类 号：R614[医药卫生—麻醉学]