老年髋部脆性骨折患者衰弱发生的危险因素分析

Analysis of risk factors for frailty in elderly patients with fragile hip fractures

目的调查老年髋部脆性骨折患者衰弱的发生现状,并分析其影响因素。方法收集乌鲁木齐市4所三级甲等医院2019年4—11月收治的接受手术治疗的196例老年髋部脆性骨折患者的临床资料,采用简易微型营养评估量表评估营养状况,采用蒙特利尔认知评估量表评估认知功能,采用简明老年抑郁量表、广泛性焦虑量表-7评估心理状态,采用Fried衰弱量表评估患者衰弱发生情况。采用多因素二元Logistic回归分析对患者衰弱发生的影响因素进行探讨。结果196例老年髋部脆性骨折患者中,衰弱、非衰弱的发生率分别为50.5%(99/196)、49.5%(97/196);不同年龄、运动频率、自我感觉健康状态、睡眠质量、日常生活能力、查尔森共病指数(CCI)、营养状态、抑郁状态、认知状态、焦虑状态的老年髋部脆性骨折患者的衰弱发生率比较,差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、自我感觉健康状态、睡眠质量、CCI、营养状态是影响老年髋部脆性骨折患者衰弱发生的主要危险因素(P<0.05)。结论老年髋部脆性骨折患者的衰弱发生率较高,其发生衰弱的主要危险因素为年龄、自我感觉健康状态、睡眠质量、CCI、营养状态。医护人员有必要在术前识别衰弱患者,及时采取跨学科衰弱管理,减少和延缓衰弱的发生,促进老年髋部脆性骨折患者的康复。

Objective To investigate the current status of frailty in elderly patients with fragile hip fractures and analyze its influencing factors.Methods The clinical data of 196 elderly patients with fragile hip fractures who underwent surgical treatment in 4 ClassⅢGrade A hospitals from April to November 2019 were collected.Mini Nutritional Assessment-Short Form(MNA-SF)was used to assess nutritional status,Montreal Cognitive Assessment(MOCA)was used to assess cognitive function,5-Item Geriatric Depression Scale(GDS-5)and Generalized Anxiety Disorder-7(GAD-7)were used to assess mental state,Fried Frailty Phenotype(FP)was used to assess the occurrence of frailty of patients and multivariate binary logistic regression analysis was used to explore the influencing factors of frailty in patients.Results Among the 196 elderly patients with fragile hip fractures,the incidence of frailty and non-frailty were 50.5%(99/196)and 49.5%(97/196),respectively.There were statistically significant differences in incidence of frailty among elderly patients with fragile hip fractures with different ages,exercise frequency,self-perceived health status,sleep quality,activity of daily living,Charlson comorbidity index(CCI),nutritional status,depression status assessment,cognitive status assessment and anxiety self-assessment(P<0.05).Logistic regression analysis showed that age,self-perceived health status,sleep quality,CCI and nutritional status were the main risk factors affecting the occurrence of fragility in elderly patients with fragile hip fractures(P<0.05).Conclusions In elderly patients with fragile hip fractures,the incidence of frailty is higher,and the main risk factors for frailty are age,self-perceived health,sleep quality,CCI and nutritional status.It is necessary for medical staff to identify frailty patients before surgery and timely adopt interdisciplinary frailty management to reduce and delay the occurrence of frailty and promote the recovery of elderly patients with fragile hip fractures.