衰弱指数对老年住院患者血压与预后相关性的影响

Effect of frailty index on relationship between blood pressure and prognosis in hospitalized elderly patients

目的探讨老年住院患者衰弱程度对血压与不良事件的影响。方法选择2014年9月~2016年3月住院患者319例,依据衰弱指数(FI)分为衰弱组43例,衰弱前期组173例和非衰弱组103例。每3个月电话随访不良事件发生情况,随访12个月。结果 3组24h平均收缩压(24hSBP)及昼间平均收缩压(dSBP)水平比较,有统计学差异(P<0.05)。衰弱组24hSBP、dSBP及夜间平均收缩压(nSBP)水平最低,其24h平均舒张压(24hDBP)及昼间平均舒张压(dDBP)水平明显低于非衰弱组,且衰弱前期组24hSBP、24hDBP、dSBP及dDBP明显低于非衰弱组(P<0.05)。FI每增加0.1,患者的全因死亡、总再住院、经急诊再住院及经门诊再住院的风险均明显增加(P<0.01)。24hSBP每升高10mm Hg(1mm Hg=0.133kPa),衰弱前期组和衰弱组全因死亡风险均明显下降,dSBP每升高10mm Hg,衰弱组总再住院风险和经门诊再住院风险均明显降低,nDBP每升高10mm Hg,衰弱前期组经急诊再住院风险明显下降(P<0.05)。结论不应忽略老年住院患者的衰弱程度,用单一降压目标值的方式管理血压。对于衰弱和衰弱前期的老年住院患者,不用或少用降压药物以维持较高水平的血压值可能是有益的。

Objective To study the effect of FI on relationship between blood pressure（BP）and adverse events occurred in hospitalized elderly patients.Methods Three hundred and nineteen hospitalized elderly patients were divided into frailty group（n=43）,prefrailty group（n=173）and non-frailty group（n=103）.The patients were followed up by telephone for 12 months,during which the incidence of adverse events was recorded every 3 months.Results A significant difference was found in 24 hSBP and dSBP among the 3 groups（P〈0.05）.The 24 hSBP,dSBP and nSBP were significantly lower in frailty group and prefrailty group than in non-frailty group（P〈0.05）.The risk of all-cause mortality,total readmission times,readmission times from emergency department and readmission times from outpatient department increased significantly when the FI increased every 0.1（P〈0.01）.The risk of all-cause mortality decreased significantly in prefrailty group and frailty group when the 24 hSBP increased every 10 mm Hg.The risk of total readmission times and readmission times from outpatient department decreased significantly in frailty group when the dSBP increased every 10 mm Hg.The risk of readmission from emergency department decreased significantly in prefrailty group when the nDBP increased every 10 mm Hg（P〈0.05）.Conclusion The frailty should not be negected in hospitalized elderly patients and their BP should be managed using single antihypertensive target value.No use or seldom use of antihypertensive drugs is beneficial for frailty and prefrailty patients to maintain normal BP.