老年脊柱退行性疾病患者术前衰弱的危险因素及预测模型构建  

Risk factors and prediction model construction for preoperative frailty in elderly patients with spinal degenerative diseases

作　　者：欧梦仙 王军[1] 段洪超[1] 张海洋[1] 刘欢 李春媛 Ou Mengxian;Wang Jun;Duan Hongchao;Zhang Haiyang;Liu Huan;Li Chunyuan(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中华现代护理杂志》2024年第27期3727-3732,共6页Chinese Journal of Modern Nursing

基　　金：首都卫生发展科研专项(首发2022-4-20114);首都医科大学宣武医院院级(护理专项)重点课题(HLZD2021007)。

摘　　要：目的筛选老年脊柱退行性疾病患者术前衰弱危险因素, 并构建风险预测模型。方法采用便利抽样法, 选取2021年9月-2022年8月在首都医科大学宣武医院神经外科行脊柱手术的324例老年患者为研究对象, 采用一般情况调查表、Barthel指数、营养风险筛查评分、简易智能状态评估量表、老年人精神抑郁量表、广泛性焦虑量表-7、阿森斯睡眠障碍量表、查尔森共病指数(CCI)、改良衰弱指数对其进行调查。采用二项Logistic回归分析探讨老年脊柱退行性疾病患者发生术前衰弱的影响因素并建立风险预测模型, 应用受试者工作特征曲线(ROC)评价模型的区分度, 并采用Hosmer-Lemeshow检验评价模型的拟合优度。结果本研究共发放问卷324份, 回收有效问卷308份, 问卷有效回收率为95.06%(308/324)。308例老年脊柱退行性疾病患者中, 56例患者发生术前衰弱。二项Logistic回归分析结果显示, 1年内跌倒、CCI、血清白蛋白、日常生活活动能力、自评健康状况是老年脊柱退行性疾病患者发生术前衰弱的影响因素(P<0.05)。预测模型的ROC曲线下面积为0.851, 灵敏度为0.786, 特异度为0.778。Hosmer-Lemeshow检验χ2值为3.764(P=0.709), 预测模型具有较好拟合度。结论 1年内跌倒、CCI、血清白蛋白、日常生活活动能力、自评健康状况是老年脊柱退行性疾病患者术前衰弱的影响因素, 基于此构建的风险预测模型可早期识别术前衰弱, 具有较好的预测效能, 值得临床推广应用。Objective To screen for preoperative frailty risk factors in elderly patients with spinal degenerative diseases and construct a risk prediction model.Methods From September 2021 to August 2022,convenience sampling was used to select 324 elderly patients who underwent spinal surgery in the Department of Neurosurgery at Xuanwu Hospital,Capital Medical University as research subjects.The patients were surveyed using the General Information Questionnaire,Barthel Index,Nutritional Risk Screening 2002,Mini-mental State Examination,Geriatric Depression Scale-15,Generalized Anxiety Disorde-7,Athens Insomnia Scale,Charlson Comorbidity Index(CCI),and Modified Frailty Index.Binary Logistic regression analysis was used to explore the influencing factors of preoperative frailty in elderly patients with spinal degenerative diseases and establish a risk prediction model.Receiver Operating Characteristic(ROC)curve was used to assess the discriminative power of the model,and Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model.Results A total of 324 questionnaires were distributed,and 308 valid questionnaires were collected,with a valid response rate of 95.06%(308/324).Among 308 elderly patients with degenerative spinal diseases,56 patients experienced preoperative frailty.Binary Logistic regression analysis showed that falls within one year,CCI,serum albumin,activities of daily living,and self-rated health status were the influencing factors for preoperative frailty in elderly patients with spinal degenerative diseases(P<0.05).The area under the ROC curve of the prediction model was 0.851,with a sensitivity of 0.786 and a specificity of 0.778.Hosmer Lemeshow test indicated that the predictive model had a good fit(X^(2)=3.764,P=0.709).Conclusions Falls within one year,CCI,serum albumin,activities of daily living,and self-rated health status are influencing factors for preoperative frailty in elderly patients with spinal degenerative diseases.The risk prediction model constructed can identify preoperative fra

关 键 词：衰弱 老年人 脊柱退行性疾病 手术 风险预测模型 

分 类 号：R687.3[医药卫生—骨科学]