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| 老年冠状动脉旁路移植术患者术前衰弱与术后慢性疼痛的相关性 |
| Association between preoperative frailty and postoperative chronic pain in elderly patients undergoing coronary artery bypass grafting |
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| DOI：10.12089/jca.2026.03.002 |
| 中文关键词: 术前衰弱 心脏手术 术后慢性疼痛 预测 老年 |
| 英文关键词: Preoperative frailty Cardiac surgery Chronic postsurgical pain Prediction Aged |
| 基金项目: |
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| 摘要点击次数: 850 |
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| 中文摘要: |
目的： 评价老年正中胸骨切开冠状动脉旁路移植术（CABG）患者术前衰弱与术后慢性疼痛（CPSP）的相关性。
方法： 选择2023年1月至2024年12月择期全麻心肺转流下行正中胸骨切开CABG的老年患者，年龄≥65岁，ASA Ⅱ或Ⅲ级。术前1 d采用FRAIL衰弱筛查量表评估患者衰弱情况，根据术前FRAIL评分将患者分为两组：非术前衰弱组（FRAIL评分＜3分）和术前衰弱组（FRAIL评分≥3分）。术后3个月电话随访，采用数字评分量表（NRS）评估患者CPSP（NRS疼痛评分≥1分）发生情况。记录患者基线资料、术中和术后指标，计算术前衰弱的发生率，计算术前衰弱对CPSP的相对危险度（RR）及95%可信区间（CI）。采用多因素Logistic回归分析调整混杂因素后获得术前衰弱与老年正中胸骨切开CABG患者CPSP的关系，采用受试者工作特征（ROC）曲线分析术前衰弱对CPSP的预测价值。
结果： 共纳入患者278例，有60例（21.6%）存在术前衰弱，有83例（29.9%）发生CPSP。与非术前衰弱组比较，术前衰弱组年龄明显偏大，女性、高血压、糖尿病、术前存在焦虑、抑郁状态比例明显偏高，术前血清白蛋白水平明显偏低，手术时间明显偏长，术后5 d平均NRS疼痛评分明显偏高（P<0.05）。与非术前衰弱组比较，术前衰弱组CPSP发生率明显偏高（P<0.05），术前衰弱对发生CPSP的RR为4.744（95%CI 3.430～6.570，P＜0.001）。在校正性别、年龄、相关合并症、术前血清白蛋白含量、术前焦虑、抑郁状态、手术时间、术后5 d平均NRS疼痛评分等混杂因素后，多因素Logistic回归分析结果显示，术前衰弱（OR=13.577，95%CI 5.934～31.064，P＜0.001）、女性（OR=3.198，95%CI 1.613～6.342，P=0.001）和术后5 d平均NRS疼痛评分＞3分（OR=2.738，95%CI 1.330～5.636，P=0.006）与老年患者CABG术后CPSP的发生明显相关（P<0.05）。术前衰弱预测CPSP的ROC曲线下面积为0.750（95%CI 0.679～0.820），敏感性为0.566，特异性为0.933。
结论： 术前衰弱的老年CABG患者CPSP发生率明显增加，术前衰弱是CPSP的预测因素。 |
| 英文摘要: |
Objective: To evaluate the association between preoperative frailty and chronic postsurgical pain (CPSP) in elderly patients undergoing median sternotomy coronary artery bypass grafting (CABG).
Methods: Elderly patients aged ≥ 65 years, ASA physical status Ⅱ or Ⅲ, scheduled for elective CABG under general anesthesia with cardiopulmonary bypass via median sternotomy were selected. Preoperative frailty was assessed using the FRAIL scale 1 day before surgery. The patients were divided into two groups: non-preoperative frail group (FRAIL scale scores < 3 points) and preoperative frail group (FRAIL scale scores ≥ 3 points). At 3 months postoperatively, telephone follow-up was conducted, and CPSP was evaluated using the numeric rating scale (NRS). Baseline characteristics, intraoperative and postoperative indicators of the two groups were recorded. The relative risk (RR) and 95% confidence interval (CI) of preoperative frailty for CPSP were calculated. Multivariate logistic regression analysis was performed to identify the relationship between preoperative frailty and CPSP in elderly CABG patients, after adjusting for potential confounding factors. The predictive value of preoperative frailty for CPSP was analyzed using receiver operating characteristic (ROC) curve.
Results: A total of 278 patients were included. Preoperative frailty was identified in 60 patients (21.6%), and CPSP occurred in 83 patients (29.9%). Compared with the non-preoperative frailty group, patients in the preoperative frailty group showed significantly increases in age, proportion of females, surgical durations, average NRS pain scores on 5 days postoperatively, incidences of comorbidities such as diabetes, hypertension, preoperative anxiety and depression, showed significantly decrease in preoperative serum albumin levels (P < 0.05). Additionally, compared with the non-preoperative frailty group, the preoperative frailty group had a higher incidence of CPSP (P < 0.05). The RR of preoperative frailty for CPSP was 4.744 (95% CI 3.430-6.570, P < 0.001). After adjusting for confounding factors such as age, gender, relevant comorbidities, preoperative serum albumin levels, preoperative anxiety and depression, surgery duration, and average NRS pain score on 5 days postoperatively, multivariate logistic regression analysis showed that preoperative frailty (OR = 13.577, 95% CI 5.934-31.064, P < 0.001), female (OR = 3.198, 95% CI 1.613-6.342, P = 0.001), and the average NRS pain score on 5 days postoperatively > 3 points (OR = 2.738, 95% CI 1.330-5.636, P = 0.006) were significantly correlated with the occurrence of CPSP in elderly CABG patients (P < 0.05). The area under the ROC curve for preoperative frailty in predicting CPSP was 0.750 (95% CI 0.679-0.820), with a sensitivity of 0.566 and a specificity of 0.933.
Conclusion: Elderly patients underwent CABG with preoperative frailty exhibit a significantly increased incidence of CPSP. Preoperative frailty was a predictor of CPSP. |
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