文章摘要
衰弱量表与衰弱表型评估对老年髋部骨折患者术后转归的预测作用
Predictive value of Frail Scale and CHS index on postoperative outcomes in elderly patients with hip fracture
  
DOI：10.12089/jca.2020.10.006
中文关键词: 老年  衰弱  术后转归  髋部骨折
英文关键词: Elderly  Frailty  Postoperative outcomes  Hip fracture
基金项目:安徽省高等学校省级质量工程项目（2017jyxm1080）
作者单位E-mail
朱守强 230022,合肥市,安徽医科大学第一附属医院麻醉科  
邢雅会 230022,合肥市,安徽医科大学第一附属医院麻醉科  
张雷 230022,合肥市,安徽医科大学第一附属医院麻醉科  
陈立建 230022,合肥市,安徽医科大学第一附属医院麻醉科  
刘学胜 230022,合肥市,安徽医科大学第一附属医院麻醉科  
顾尔伟 230022,合肥市,安徽医科大学第一附属医院麻醉科 zhlanesth@yeah.net 
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中文摘要:
      
目的 比较衰弱量表与衰弱表型评估对老年髋部骨折患者术后转归的预测作用。
方法 2019年9月至2020年1月髋部骨折患者120例，男65例，女55例，年龄≥65岁，术前1 d分别采用衰弱量表和衰弱表型完成衰弱评估，依据两个量表各自评估的结果将患者分为：非衰弱期、衰弱前期和衰弱期，通过κ检验比较两种方法的一致性，并通过χ2检验确定衰弱与术后转归各项指标之间的关系。
结果 采用衰弱量表和衰弱表型检出老年髋部骨折患者术前衰弱期的比例分别为15.0%、22.5%，一致性检验κ值为0.55（95%CI 0.42～0.67）。根据衰弱量表评估结果，衰弱期患者术后总并发症（RR=4.5，95%CI 0.9～21.5）、术后住院时间超过5 d（RR=3.5，95%CI 1.0～12.2）和PACU停留时间超过60 min（RR=6.9，95%CI 1.2～40.1）的发生风险明显高于非衰弱期患者，衰弱前期患者术后住院时间超过5 d的发生风险明显高于非衰弱期患者（RR=2.7，95%CI 1.0～7.0）。根据衰弱表型评估结果，衰弱前期患者术后总并发症的发生风险明显高于非衰弱期患者（RR=4.7，95%CI 1.0～22.9），衰弱期患者PACU停留时间超过60 min的发生风险明显高于非衰弱期患者（RR=5.3，95%CI 1.0～28.6）。
结论 衰弱量表和衰弱表型作为老年髋部骨折术前衰弱评估工具，两者评估一致性中等，其中衰弱量表在预测术后转归方面更具优势。
英文摘要:
      
Ojective To compare the predictive effects of the Frail Scale and the CHS index on postoperative outcomes in elderly patients with hip fractures.
Methods A total of 120 patients with hip fractures (age ≥ 65 years) hospitalized between September 2019 and January 2020 were included in the study. The frailty assessment was carried out by the Frail Scale and CHS index 1 day before operation, and the patients was divided into non-fraity, early frailty and frailty, kappa test was used to compare the consistency of the two assessment methods, and chi-square test was used to determine the relationship between frailty and postoperative outcomes.
Results The proportion of patients with frailty detected by the Frail Scale and CHS index was 15.0% and 22.5%, respectively, the kappa value of consistency test was 0.55 (95% CI 0.42-0.67). The results of the Frail Scale evaluation showed that the incidence risk of postoperative complications (RR = 4.5, 95% CI 0.9-21.5), length of stay (LOS) over 5 days (RR = 3.5, 95% CI 1.0-12.2) and PACU time over 60 minutes (RR = 6.9, 95% CI 1.2-40.1) in patients with frailty was higher than that patients without frailty, the incidence risk of LOS over 5 days in patients with early frailty was higher than that patients in non-frailty (RR = 2.7, 95% CI 1.0-7.0). The results of the CHS index evaluation showed that the incidence risk of PACU over 60 minutes in patients with frailty was higher than that patients without frailty (RR = 5.3, 95% CI 1.0-28.6), and the incidence risk of postoperative complications in patients with early frailty was higher than that patients without frailty (RR = 4.7, 95% CI 1.0-22.9).
Conclusion As tools for preoperative frailty assessment in elderly patients with hip fractures, Frailty Scale and CHS index are moderately consistent, and the Frailty Scale is more advantageous in predicting postoperative outcomes.
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