住院待手术老年膝关节骨性关节炎患者衰弱现况及其影响因素分析

Prevalence and Associated Factors of Preoperative Frailty in Elderly Patients with Knee Osteoarthritis Undergoing Surgery

背景作为一类特殊手术人群,老年患者手术风险大,术后恢复效果不佳,且常伴有较高的术后不良结局发生率。越来越多的临床研究表明术前衰弱与术后不良结局的发生具有相关性。目的了解住院待手术老年膝关节骨性关节炎(KOA)患者衰弱现状,并分析其影响因素。方法采用目的抽样法,选取2018年11月—2019年4月于贵州医科大学附属医院、贵州省骨科医院和贵阳市第四人民医院骨科病房住院待手术的符合纳入标准的230例老年KOA患者为调查对象。采用自行设计的一般资料调查表、衰弱筛查量表(FRAIL量表)、修订版面部表情疼痛量表(FPS-R)、美国膝关节协会评分表(AKS),以面对面逐一询问并填写的方式进行问卷调查,并测量患者术前膝关节屈曲度。采用二分类Logistic回归分析探究住院待手术老年KOA患者衰弱的影响因素。结果共发放问卷230份,回收有效问卷230份,有效回收率100.0%。230例住院待手术老年KOA患者中非衰弱74例(32.2%),衰弱156例(67.8%)。二分类Logistic回归分析结果显示,家庭人均月收入〔≤2000元:OR=12.598,95%CI(2.771,57.272),P<0.05;2001~元:OR=5.972,95%CI(1.318,27.053),P<0.05〕、体质指数(BMI)〔异常:OR=3.007,95%CI(1.426,6.339),P<0.05〕、膝关节疼痛年限〔6~年:OR=2.447,95%CI(1.016,5.895),P<0.05;11~年:OR=6.072,95%CI(2.257,16.340),P<0.05;>15年:OR=7.638,95%C(I 1.763,33.097),P<0.05〕、FPS-R评分〔>6分:OR=3.506,95%C(I 1.672,7.354),P<0.05〕是住院待手术老年KOA患者衰弱的影响因素。结论住院待手术老年KOA患者衰弱发生率较高(67.8%),医护人员应高度重视低收入、BMI异常、疼痛年限长及疼痛程度重的住院待手术老年KOA患者,及早对其进行术前衰弱评估及筛查,从而制定更为科学合理的诊疗护理计划,预防或减缓衰弱的发生发展。

Background The elderly patients,a special group of patients,have a high risk of surgery,poor postoperative recovery,and a high incidence of adverse postoperative outcomes.More and more clinical studies show that preoperative frailty is correlated with postoperative adverse outcomes.Objective To investigate the prevalence of preoperative frailty and its influencing factors in elderly patients with knee osteoarthritis(KOA)who were hospitalized for surgery.Methods By use of purposive sampling method,totally 230 elderly patients with KOA who were hospitalized for surgery were selected from the Affiliated Hospital of Guizhou Medical University,Guizhou Orthopedics Hospital and the Fourth People's Hospital of Guiyang during November 2018 to April 2019.All patients received an interviewer-administered questionnaire survey using selfdesigned General Data Questionnaire,FRAIL Scale,Faces Pain Scale-Revised(FPS-R),American Knee Society(AKS)score and measured preoperative knee flexion.Binary Logistic regression analysis was used to investigate the influencing factors of preoperative frailty in elderly.Results A total of 230 questionnaires were issued,and 230 effective questionnaires were recovered,with an effective recovery rate 100%.156(67.8%)were found with frailty,and other 74(32.2%)without.Binary Logistic regression analysis showed that household monthly income per person〔≤2000 yuan:OR=12.598,95%CI(2.771,57.272),P<0.05;>2001 yuan:OR=5.972,95%CI(1.318,27.053),P<0.05〕,BMI〔abnormal:OR=3.007,95%CI(1.426,6.339),P<0.05〕,duration of knee pain〔6-10 years:OR=2.447,95%CI(1.016,5.895),P<0.05;11-14 years:OR=6.072,95%CI(2.257,16.340),P<0.05;>15 years:OR=7.638,95%CI(1.763,33.097),P<0.05〕,FPS-R score〔>6 points:OR=3.506,95%CI(1.672,7.354),P<0.05〕were the influencing factors of preoperative frailty patients with KOA undergoing surgery.Conclusion The prevalence of preoperative frailty in preoperative frailty patients with KOA undergoing surgery was high(67.8%).Healthcare workers should attach great importance to the elderly KOA patients with low income,abnormal BMI,long-term pain and severe pain,and timely screening preoperative frailty in them to develop a more scientific and rational diagnosis and treatment plan to prevent or delay the development of frailty.