FRAIL量表在老年关节置换术后压力性损伤风险预测中的应用  

The use of the FRAIL scale in predicting the risk of postoperative pressure injury in older patients undergoing joint replacement surgery

作　　者：姜淑伟 马良[1] 康保絮 王志浩[2] JIANG Shuwei;MA Liang;KANG Baoxu;WANG Zhihao(Department of Orthopedic Surgery,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Health Care/Geriatrics,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China)

机构地区：[1]山东大学齐鲁医院骨科,山东济南250012 [2]山东大学齐鲁医院保健科/老年医学科,山东济南250012

出　　处：《山东大学学报（医学版）》2024年第11期54-66,共13页Journal of Shandong University:Health Sciences

摘　　要：目的 本研究旨在通过疲劳、抗阻力、步行、疾病和体质量减轻(fatigue, resistance, ambulation, illnesses&loss of weight, FRAIL)量表评估拟行关节置换术老年患者的衰弱状态,探讨术前衰弱对术后压力性损伤风险变化的影响,并评估FRAIL量表评分结合常见实验室检查指标在预测老年关节置换术患者术后压力性损伤风险变化中的有效性。方法 本研究为横断面研究,选取2021年5月至2023年6月山东大学齐鲁医院骨科住院的60岁及以上拟行关节置换术患者348例。患者按入院时间分为训练集(n=256)和验证集(n=92)。采用FRAIL量表评估患者术前衰弱状态,将患者分为3组:0分为无衰弱组,1~2分为衰弱前期组,3~5分为衰弱组。通过Braden量表评估压力性损伤风险,并通过医院病案管理系统收集患者入院诊断、手术方式和术前生化指标。采用单因素Logistic回归和最小绝对收缩与选择算子回归(least absolute shrinkage and selection operator, LASSO)筛选重要预测变量,并构建多因素Logistic回归模型。使用列线图可视化模型,模型的拟合优度、校准及预测能力通过Hosmer-Lemeshow检验、受试者工作特征曲线(receiver operating characteristic, ROC)及曲线下面积(area under the curve, AUC)进行评估,同时采用决策曲线分析(decision curve analysis, DCA)评估其临床应用价值。通过Bootstrap方法对模型进行内部验证,并使用外部验证集数据对模型进行外部验证。此外,基于年龄和手术方式进行亚组分析。结果 348例患者中,无衰弱者78例,衰弱前期者204例,衰弱者66例。FRAIL评分、中性粒细胞、缺血修饰白蛋白及钾离子浓度是术后压力性损伤风险的独立预测因素(P<0.05)。FRAIL评分每增加1分,术后压力性损伤的发生风险增加1.719倍(OR=1.719, 95%CI:1.171~2.524,P=0.006);中性粒细胞OR为1.222(95%CI:1.028~1.451,P=0.023);缺血修饰白蛋白OR为1.117(95%CI:1.051~1.187,P<0.001);钾离子浓度OR�Objective To assess the frailty status of older patients undergoing joint replacement surgery using the fatigue,resistance,ambulation,illnesses&loss of weight(FRAIL)scale.It further explored the impact of preoperative frailty on postoperative pressure injury and evaluated the effectiveness of combining FRAIL scores with common laboratory indicators in predicting postoperative pressure injury risk.Methods This cross-sectional study included 348 patients aged 60 years and older who were admitted to the Department of Orthopedics,Qilu Hospital of Shandong University,for joint replacement surgery between May 2021 and June 2023.Patients were divided into a training set(n=256)and avalidation set(n=92)based on admission time.The FRAIL scale was used to assess preoperative frailty,and the patients were divided into three groups:non-frail(0 points),pre-frail(1-2 points),and frail(3-5 points)groups.The Braden scale was used to assess pressure injury risk.Data on admission diagnoses,surgical procedures,and preoperative biochemical indicators were collected using the hospitals medical record management system.Univariate Logistic regression and least absolute shrinkage and selection operator(LASSO)regression were used to screen important predictive variables,and a multivariate Logistic regression model was constructed.A nomogram was constructed to visualise the model.The goodness-of-fit,calibration,and predictive ability of the model were evaluated using the Hosmer-Lemeshow test,receiver operating characteristic(ROC)curve,and area under the curve(AUC).Decision curve analysis(DCA)was employed to assess clinical utility.The Bootstrap method was used for internal validation and external validation was performed using the validation set.Subgroup analysis was performed based on age and surgical procedures.Results Among the 348 patients,78 were non-frail,204 were pre-frail,and 66 were frail.FRAIL score,neutrophils,ischaemia-modified albumin(IMA),and potassium ion concentration were independent predictors of postoperative pressure in

关 键 词：骨科 衰弱 老年人 关节置换 压力性损伤 

分 类 号：R684.3[医药卫生—骨科学]