临床衰弱评估与老年脑肿瘤切除患者术后不良结局的关系研究  

Relationship between clinical frailty assessment and adverse outcomes in elderly patients after brain tumor resection

作　　者：杨冉[1] 郝新宇 欧阳春磊 李英夫 曹江北[1] 仝黎 Yang Ran;Hao Xinyu;Ouyang Chunlei;Li Yingfu;Cao Jiangbei;Tong Li(Department of Anesthesiology,the First Medical Center of PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心麻醉科,北京100853

出　　处：《国际麻醉学与复苏杂志》2023年第3期238-242,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家重点研发计划(2018YFC2001901)。

摘　　要：目的探讨术前衰弱状态与老年脑肿瘤切除患者术后不良结局的潜在关系,为此类患者围手术期综合干预提供有效参考依据。方法回顾性分析2014年1月8日至2019年8月8日解放军总医院第一医学中心553例65岁以上脑肿瘤切除术患者的病例资料。术前衰弱状态由5项改良衰弱指数(the 5-factor modified frailty index,mFI-5)进行评估。收集患者一般资料、mFI-5评分变量及术后并发症信息,构建mFI-5评分。根据mFI-5评分划分为衰弱组(157例,mFI-5≥0.4分)与非衰弱组(396例,mFI-5<0.4分)。主要结局为1年全因死亡率,次要结局为肺部感染与脑卒中。采用COX回归分析1年全因死亡情况,采用Logistic回归分析脑卒中与肺部感染情况。绘制Kaplan-Meier生存曲线,用Log-Rank法比较两组患者的生存曲线。结果衰弱组术后发生1年全因死亡、肺部感染、脑卒中概率均明显高于非衰弱组(P<0.05)。衰弱组1年全因死亡率是非衰弱组的3.987倍[比值比(odds ratio,OR)3.987,95%CI 1.543~5.978,P=0.011]。Kaplan-Meier曲线显示衰弱组患者预后较非衰弱组差(P<0.05)。衰弱组出现术后脑卒中的概率是非衰弱组的4.830倍(OR 4.830,95%CI 2.847~8.196,P<0.001),衰弱组出现术后肺部感染的概率是非衰弱组的4.911倍(OR 4.911,95%CI 1.921~7.214,P=0.003)。结论衰弱是老年脑肿瘤切除患者出现术后不良结局的独立危险因素。mFI-5≥0.4分可作为识别衰弱状态的有效指标,为患者围手术期综合干预提供有效参考依据。Objective To explore the potential relationship between preoperative frailty condition and postoperative adverse outcome in elderly patients undergoing brain tumor resection,in order to provide effective evidence for comprehensive perioperative in-tervention in such patients.Methods A total of 553 patients aged 65 years and older who underwent brain tumor resection at the First Medical Center of PLA General Hospital from January 8,2014 to August 8,2019 were enrolled and their clinical data were retro-spectively analyzed.Their preoperative frailty was assessed by the 5-factor modified weakness index(mFI-5).The general data,mFI-5 score variables and postoperative complications were collected to construct the mFI-5 score.Based on the mFI-5 score,the patients were divided into two groups:a frail group(n=157,mFI-5≥0.4 score)and a non-frail group(n=396,mFI-5<0.4 score).The primary out-come was one-year all-cause mortality,and the secondary outcomes were pulmonary infection and stroke.The one-year all-cause death was analyzed by COX regression,and stroke and pulmonary infection were analyzed by logistic regression.Kaplan-Meier survival curves were plotted and Log-Rank was used to compare the survival curves of the two groups.Results The frail group showed re-markably higher percentages of postoperative one-year all-cause death,pulmonary infection,and stroke than the non-frail group(P<0.05).The probability of one-year all-cause death in the frail group was 3.987 times as high as that in the non-frail group[odds ratio(OR)3.987(95%CI 1.542,5.978),P=0.011].The Kaplan-Meier curves showed poorer prognosis in the frail group than those in the non-frail group(P<0.05).The frail group presented a probability stroke which was 4.830 times as high as the non-frail group[OR 4.830(95%CI 2.847,8.196),P<0.001]and a probability of pulmonary infection which was 4.911 times as high as the non-frail group[OR 4.911(95%CI 1.921,7.214),P=0.003].Conclusions Frailty is an independent risk factor for poor postoperative outcome in elderly patien

关 键 词：改良衰弱指数 脑肿瘤切除术 术后并发症 老年患者 

分 类 号：R739.41[医药卫生—肿瘤]