5项改良衰弱指数预测胰十二指肠切除术近期预后的价值探讨  

Values of 5-item modified frailty index in predicting the short-term prognosis of pancreaticoduodenectomy

作　　者：杜滨和 徐楠 杨云川 崔培元[1] Du Binhe;Xu Nan;Yang Yunchuan;Cui Peiyuan(Department of Hepatobiliary Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院肝胆外科,233004

出　　处：《中华普通外科学文献（电子版）》2023年第6期444-448,共5页Chinese Archives of General Surgery(Electronic Edition)

摘　　要：目的研究5项改良衰弱指数(5i-mFI)预测胰十二指肠切除术(PD)近期并发症、30 d内死亡及预后的价值。方法回顾性收集2017年3月至2022年10月在蚌埠医学院第一附属医院行PD手术的269例患者资料。根据高血压、糖尿病、慢性阻塞性肺疾病、充血性心力衰竭、依赖性功能状态5个变量得分情况,进行5i-mFI评分。通过5i-mFI评分将患者分为非衰弱组(0或1分)和衰弱组(≥2分),探讨5i-mFI评分与PD术后近期并发症及30 d内死亡的关系。使用曲线下面积(AUC)判断5i-mFI评分对术后近期并发症的鉴别能力。结果55例(20.4%)纳入衰弱组,214例(79.6%)纳入非衰弱组。衰弱组患者在术后30 d内发生的轻微并发症、主要并发症、任何并发症及30 d内死亡率明显高于非衰弱组,且概率随着5i-mFI评分上升而逐渐增加,差异有统计学意义(均P<0.01)。衰弱组患者术后并发症中B/C级胰瘘、胃排空障碍、乳糜漏、胆漏、肺部并发症、心脏并发症、深静脉血栓等并发症发生率更高,差异均有统计学意义(P<0.05)。5i-mFI评分预测PD术后近期并发症的AUC为0.843(标准误=0.03,95%CI:0.784~0.903,P<0.01),准确性较好。结论与非衰弱患者相比,5i-mFI≥2分的衰弱患者术后并发症及30 d内死亡的概率更高,5i-mFI评分对PD术后近期并发症及30 d内死亡具有一定预测价值,有助于临床决策。Objective To study the relationship between 5-item modified frailty index(5i-mFI)and short-term complications,30-day mortality and prognosis of pancreaticoduodenectomy(PD).Methods The data of 269 patients who underwent PD in the First Affiliated Hospital of Bengbu Medical College from March 2017 to October 2022 were retrospectively collected.According to the scores of 5 variables including hypertension,diabetes,chronic obstructive pulmonary disease,congestive heart failure and dependent functional status,5i-mFI score was performed.The patients were divided into non-frail group(0 or 1 point)and frail group(≥2 points)by 5i-mFI score.The relationship between 5i-mFI score and short-term complications and death within 30 days after PD was discussed.The area under the curve(AUC)was used to determine the ability of 5i-mFI score to identify recent postoperative complications.Results 55 cases(20.4%)were included in the frailty group and 214 cases(79.6%)were included in the non-frailty group.The mild complications,major complications,any complications and mortality within 30 days after operation in the frailty group were significantly higher than those in the non-frailty group,and the probability increased gradually with the increase of 5i-mFI score,the differences were statistically significant(all P<0.01).The incidence of postoperative complications such as grade B/C pancreatic fistula,gastric emptying disorder,chylous leakage,bile leakage,pulmonary complications,cardiac complications,and deep vein thrombosis was higher in the frailty group(P<0.05).The AUC of 5i-mFI score for predicting short-term complications after PD was 0.843(standard error=0.03,95%CI:0.784-0.903,P<0.01),with good accuracy.Conclusions Compared with non-frail patients,frail patients with 5i-mFI≥2 points have higher probability of postoperative complications and 30-day mortality.The 5i-mFI score has certain predictive value for short-term complications and 30-day mortality after PD,which is helpful for clinical decision-making.

关 键 词：胰十二指肠切除 5项改良衰弱指数 术后并发症 30天死亡 

分 类 号：R47[医药卫生—护理学]