老年结直肠肿瘤手术患者衰弱变化轨迹及其影响因素分析  

Analysis of the trajectory of frailty and its influencing factors in elderly patients undergoing colorectal tumor surgery

作　　者：葛莉丽 陈叡喆 李垚 姜妍[1] 陈小敏 吴逸梅 夏敏 吴茜[1] Ge Lili;Chen Ruizhe;Li Yao;Jiang Yan;Chen Xiaomin;Wu Yimei;Xia Min;Wu Qian(Department of Nursing,Shanghai 10th People's Hospital,Shanghai 200072,China;Operating Room,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,Zhejiang,China)

机构地区：[1]上海市第十人民医院护理部,上海200072 [2]温州医科大学附属第一医院手术室,浙江温州325015

出　　处：《肿瘤综合治疗电子杂志》2025年第2期118-125,共8页Journal of Multidisciplinary Cancer Management(Electronic Version)

基　　金：上海市申康医疗中心医企融合创新支撑技能培训专项(SHDC2023CRS023);上海市抗癌协会肿瘤护理专委会护理科研基金“护航”计划(SACA-HH202308);上海市第十人民医院研究型医师人才项目(YJXHS-006);上海市第十人民医院护理部课题(SYHLKY-202301)。

摘　　要：目的分析老年结直肠肿瘤手术患者衰弱变化轨迹并分析其影响因素。方法采用便利抽样法前瞻性选取2023年1—12月于上海市第十人民医院行择期手术的242例老年结直肠肿瘤患者作为研究对象。采用一般资料调查表、格罗宁根衰弱指标(Groningen frailty indicator,GFI)和安德森症状评估量表(MD Anderson symptom inventory,MDASI),分别在手术前1 d、术后1周、术后1个月、术后3个月对患者进行衰弱评估,建立增长混合模型识别衰弱变化轨迹的趋势。将单因素Logistic回归分析存在统计学意义的变量纳入多分类结局Logistic回归模型分析影响因素。结果经多次重复拟合,最终在老年结直肠肿瘤手术患者中确定了无衰弱变化轨迹组(n=90,C1组)、衰弱增强变化轨迹组(n=73,C2组)、中衰弱变化轨迹组(n=54,C3组)和高衰弱变化轨迹组(n=25,C4组)。四组衰弱潜类别变化轨迹在年龄、教育程度、婚姻状况、居住状态、冠心病、病理分期、并发症、营养风险筛查2002(nutritional risk screening 2002,NRS 2002)评分、血红蛋白和白蛋白比较差异均有统计学意义(均P<0.05)。以C1组为参照,多分类Logistic回归模型分析显示,教育程度高中及以下和病理分期Ⅲ~Ⅳ期均为C2组的危险因素(均P<0.05);年龄>70岁、有冠心病、病理分期Ⅲ~Ⅳ期和NRS 2002评分≥3分均为C3组的危险因素(均P<0.05);年龄>70岁、有冠心病、病理分期Ⅲ~Ⅳ期和NRS 2002≥3分均为C4组的危险因素(均P<0.05)。MDASI分析表明,术前,C4组和C3组患者症状严重程度和症状妨碍生活程度总分均显著高于C1组和C2组(均P<0.05)。术后3个月,C4组患者症状严重程度总分均显著高于C1组和C2组(均P<0.05);C4组患者症状妨碍生活程度总分均显著高于C1组、C2组和C3组(均P<0.05),且C1组、C3组和C4组患者的症状严重程度和症状妨碍生活程度总分均较术前下降,但C2组均上升。C2组患者术后3个月与术前症状Objective To analyze the trajectory of frailty change and its influencing factors in elderly patients undergoing colorectal cancer surgery.Method A prospective study was conducted to select 242 elderly patients with colorectal cancer who underwent elective surgery in Shanghai 10th People's Hospital from January to December 2023 by convenient sampling method.Using the general data questionnaire,Groningen frailty indicator(GFI)and MD Anderson symptom inventory(MDASI).Fraility was evaluated 1 day before surgery,1 week after surgery,1 month after surgery,and 3 months after surgery,and a mixed growth model was established to identify the trend of fraility change trajectory.The variables with statistical significance of single factor were included in the multi-classification outcome Logistic regression model to analyze the influencing factors.Result After repeated fitting,a no-frailty change locus group(n=90,group C1),a frailty enhancement change locus group(n=73,group C2),a medium-frailty change locus group(n=54,group C3),and a high-frailty change locus group(n=25,group C4)were finally identified in elderly patients undergoing colorectal tumor surgery.There were significant differences in age,education level,marital status,living status,coronary heart disease,pathological stage,complications,nutritional risk screening 2002(NRS 2002)score,hemoglobin and albumin among the four groups(all P<0.05).With group C1 as the reference,multiple Logistic regression model analysis showed that high school education and below and pathological stageⅢ―Ⅳwere risk factors for group C2(all P<0.05).Age>70 years old,coronary heart disease,pathological stageⅢ―Ⅳand NRS 2002 score≥3 scores were all risk factors in C3 group(all P<0.05).Age>70 years old,coronary heart disease,pathological stageⅢ-Ⅳand NRS 2002≥3 scores were risk factors in C4 group(all P<0.05).MDASI analysis showed that the total score of symptom severity and symptom disturbance degree of life in C4 group and C3 were significantly higher than those in the high

关 键 词：结直肠肿瘤 老年患者 衰弱变化轨迹 增长混合模型 

分 类 号：R735.3[医药卫生—肿瘤]