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| 术前衰弱对老年患者心脏手术后肺部并发症的预测价值 |
| Predictive value of preoperative frailty for pulmonary complications after cardiac surgery in elderly patients |
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| DOI：10.12089/jca.2023.12.004 |
| 中文关键词: 心脏手术；衰弱 老年 术后肺部并发症 |
| 英文关键词: Cardiac surgery Frailty Aged Postoperative pulmonary complications |
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| 中文摘要: |
目的 探讨术前衰弱对于老年患者心脏手术后肺部并发症（PPCs）的预测价值。
方法 选择2022年7月至2023年1月行择期开胸心脏手术老年患者162例，男109例，女53例，年龄65～83岁，BMI 18～36 kg/m2，ASA Ⅱ—Ⅳ级。根据是否发生PPCs将患者分为两组：PPCs组（n=57）和非PPCs组（n=105）。收集一般资料、吸烟史、饮酒史、EuroSCORE Ⅱ、衰弱情况、慢性合并症（高血压、糖尿病、心肌梗死、肺动脉高压、慢性阻塞性肺疾病、睡眠呼吸暂停综合征等）、Hb、肌酐、白蛋白、肺功能指标、左心室射血分数、手术类型、手术时间、主动脉钳夹时间和心肺转流时间。将单因素回归分析中P<0.2及具有临床意义的因素纳入多因素Logistic回归分析，通过受试者工作特征（ROC）曲线下面积（AUC）比较Fried衰弱量表和EuroSCOREⅡ对PPCs的预测效能。
结果 有57例（35.2%）患者发生PPCs。多因素Logistic回归分析显示，衰弱（OR=3.14，95%CI 1.05～9.37，P<0.05）和EuroSCORE Ⅱ（OR=2.16，95%CI 1.01～4.60，P<0.05）是发生PPCs的危险因素。Fried衰弱量表的预测效能（AUC=0.76，95%CI 0.68～0.82）明显高于EuroSCORE Ⅱ （AUC=0.65，95%CI 0.57～0.72）（P<0.05）。
结论 术前衰弱是老年患者心脏手术后肺部并发症的独立危险因素，与传统的风险预测指标EuroSCORE Ⅱ比较，Fried衰弱量表的预测效能更佳。 |
| 英文摘要: |
Objective To investigate the predictive value of preoperative frailty for pulmonary complications (PPCs) after cardiac surgery in elderly patients.
Methods A total of 162 elderly patients, 109 males and 53 females, aged 65-83 years, BMI 18-36 kg/m2, ASA physical status Ⅱ-Ⅳ, underwent elective open heart surgery from July 2022 to January 2023 were collected. The patients were divided into two groups according to the occurrence of PPCs: the PPCs group (n = 57) and the non-PPCs group (n = 105). General information, smoking history, alcohol consumption history, EuroSCORE Ⅱ, frailty, chronic comorbidities (hypertension, diabetes mellitus, myocardial infarction, pulmonary hypertension, chronic obstructive pulmonary disease, sleep apnea syndrome, etc.), Hb, creatinine, albumin, pulmonary function indices, left ventricular ejection fraction, type of surgery, duration of surgery, aortic clamping time, and cardiopulmonary bypass time were collected. Factors with P < 0.2 and clinically significant in the univariate regression analysis were included in the multivariate logistic regression analysis, and the predictive efficacy of the Fried frailty scale and EuroSCORE Ⅱ for PPCs were compared by the area under the ROC curve (AUC).
Results PPCs occurred in 57 patients (35.2%). Multifactorial Logistic regression analysis showed that frailty (OR = 3.14, 95% CI 1.05-9.37, P < 0.05) and EuroSCORE Ⅱ (OR = 2.16, 95% CI 1.01-4.60, P < 0.05) were risk factors for the development of PPCs. The predictive power of Fried frailty scale (AUC = 0.76， 95% CI 0.68-0.82) was significantly higher than that of EuroSCORE Ⅱ (AUC = 0.65, 95% CI 0.57-0.72) (P < 0.05).
Conclusion Preoperative frailty is the independent risk factors for pulmonary complications after cardiac surgery in elderly patients, and the Fried frailty scale has a better predictive efficacy compared to EuroSCORE Ⅱ, a traditional risk predictor． |
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