老年急诊创伤患者衰弱现状及其危险因素  

Frailty status and risk factor analysis in elderly emergency trauma patients

作　　者：高悦 陈可 蒋丹丹 佘柯仪 张红涛 阳欣君 张雯 周雨彤 陈尧 尹心红[1] GAO Yue;CHEN Ke;JIANG Dandan;SHE Keyi;ZHANG Hongtao;YANG Xinjun;ZHANG Wen;ZHOU Yutong;CHEN Yao;YIN Xinhong(School of Nursing,University of South China,Hengyang 421001;Department of Emergency,Second Affiliated Hospital,University of South China,Hengyang 421001;Department of Obstetrics and Gynecology,First Affiliated Hospital,University of South China,Hengyang 421001,China)

机构地区：[1]南华大学护理学院,衡阳421001 [2]南华大学附属第二医院急诊科,衡阳421001 [3]南华大学附属第一医院妇产科,衡阳421001

出　　处：《临床与病理杂志》2025年第1期46-54,共9页Journal of Clinical and Pathological Research

基　　金：湖南省自然科学基金(2024JJ6400,2023JJ30528);湖南省卫生健康委一般指导课题(D202314058794);大学生创新创业训练计划(230XCX250);衡阳市社会科学基金(2023D009)。

摘　　要：目的:随着人口老龄化趋势不断加剧,老年急诊创伤患者不断增多。衰弱可显著增高患者不良预后风险,早期识别与干预衰弱状态可改善患者临床结局。本研究探讨老年急诊创伤患者衰弱现状并分析其危险因素,为筛查衰弱高危人群提供依据。方法:选取2023年12月至2024年6月南华大学附属第一医院和南华大学附属第二医院急诊科收治的306例老年创伤患者作为研究对象,收集患者基本情况、创伤状况、衰弱状况以及实验室指标。采用Logistic回归分析探讨老年急诊创伤患者发生衰弱的危险因素。结果:本研究306例患者中,男216例,女90例,年龄为68.00(64.00,73.00)岁;创伤特异性衰弱指数(Trauma Specific Frailty Index,TSFI)得分为0.23(0.22,0.40),评估为衰弱者152例(49.67%),非衰弱者154例(50.33%)。单因素分析结果显示:衰弱者与非衰弱者在红细胞计数、血清白蛋白、年龄、心率、格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分、损伤严重程度评分(Injury Severity Score,ISS)、白细胞计数、中性粒细胞计数、血红蛋白、血乳酸、C反应蛋白、D-二聚体、白细胞介素-6、合并慢性病数量、头颈部创伤、胸部创伤、腹部创伤、多发伤、创伤后休克、急诊输血、创伤原因等方面比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示:年龄大、合并慢性病数量多、ISS高、头颈部创伤、血红蛋白水平降低、血清白蛋白水平降低、白细胞介素-6水平升高、血乳酸水平升高均是老年急诊创伤患者发生衰弱的独立危险因素(均P<0.05)。结论:老年急诊创伤患者衰弱发生率较高,年龄大、合并慢性病数量多、ISS高、头颈部创伤、血红蛋白水平降低、血清白蛋白水平降低、白细胞介素-6水平升高、血乳酸水平升高是老年急诊创伤患者发生衰弱的独立危险因素。临床医护人员应针对这些危险因素进行干预,减少Objective:With the continuous aging of the population,the number of elderly emergency trauma patients has increased.Frailty significantly increases the risk of poor prognosis in these patients,and early identification and intervention can improve clinical outcomes.This study aims to investigate the frailty status in elderly emergency trauma patients and analyze the associated risk factors,providing a basis for screening high-risk frailty populations.Methods:A total of 306 elderly trauma patients treated in the emergency departments of the First Affiliated Hospital and the Second Affiliated Hospital of University of South China from December 2023 to June 2024 were selected.Basic information,trauma status,and laboratory indicators were collected.The Trauma-Specific Frailty Index(TSFI)was used to assess frailty status.Logistic regression analysis was conducted to explore the risk factors for frailty in elderly emergency trauma patients.Results:Among the 306 patients,216 were male,and 90 were female,with a median age of 68.00(64.00,73.00)years.The median TSFI score was 0.23(0.22,0.40),with 152(49.67%)patients classified as frail and 154(50.33%)patients as non-frail.Univariate analysis showed significant differences in red blood cell count,serum albumin,age,heart rate,Glasgow Coma Scale(GCS),Injury Severity Score(ISS),white blood cell count,neutrophil count,hemoglobin,blood lactate,C-reactive protein,D-dimer,interleukin-6,number of chronic diseases,head and neck trauma,chest trauma,abdominal trauma,multiple injuries,post-traumatic shock,emergency transfusion,trauma causes,and other factors between the frail and non-frail patients(all P<0.05).Multivariate logistic regression analysis showed that older age,more chronic diseases,higher ISS scores,head and neck trauma,decreased hemoglobin levels,lower serum albumin levels,elevated interleukin-6 levels,and higher blood lactate levels were independent risk factors for frailty in elderly emergency trauma patients(all P<0.05).Conclusion:Frailty occurs at a high rate in elderl

关 键 词：老年人 急诊 创伤 衰弱 创伤特异性衰弱指数 损伤严重程度评分 危险因素 

分 类 号：R641[医药卫生—外科学]