术前衰弱状态评估对心脏外科术后成年患者住院期间谵妄预测的价值分析

The value of preoperative frailty assessment in the prediction of delirium during hospitalization in adult patients after cardiac surgery

目的 探讨术前衰弱状态评估对心脏外科术后成年患者住院期间谵妄的预测价值。方法 前瞻性收集2017年1月至2018年6月就诊于新疆医科大学第一附属医院和四川省人民医院行心脏手术成年患者232例,采用FRIED综合征标准对患者进行衰弱状态评估,依据衰弱状态将患者分为无衰弱、衰弱前期和衰弱组,主要研究指标为住院期间心脏外科术后谵妄(PCSD),采用Logistic回归分析影响PCSD的独立影响因素。结果 232例患者中发生PCSD 28例。无衰弱、衰弱前期和衰弱组患者PCSD发生率差异有统计学意义(P<0.05)。多因素Logistic回归分析显示:衰弱状态、年龄、NT-proBNP、白细胞计数和白蛋白为PCSD的独立影响因素(P<0.05)。ROC曲线分析显示,虚弱状态判断PCSD的曲线下面积显著大于其他PCSD的独立影响因素(P<0.05)。结论 术前衰弱状态评估可用于评估心脏外科术后成年患者住院期间谵妄风险,有助于早期危险分层,指导精准干预。

Objective To explore the value of preoperative frailty assessment in the prediction of delirium during hospitalization in adult patients after cardiac surgery.Methods From January 2017 to June 2018, we prospectively and continuously collected 232 adult patients who underwent cardiac surgery in our hospitals. The frailty status of patients was evaluated by FRIED syndrome criteria. According to the frailty status, the patients were divided into a no frailty group, a prefrailty group and a frailty group. The main research indicator was post-cardiac surgery delirium(PCSD) during hospitalization. Logistic regression analysis was used to analyze the independent influencing factors of PCSD.Results Of the 232 patients, 28 patients developed PCSD. There was a statistically significant difference in the incidence of PCSD among the three groups(P<0.05). Multivariate logistic regression analysis showed that the frailty, age, NT-proBNP, leukocyte count and albumin were independent influencing factors of PCSD(P<0.05). ROC curve analysis showed that the area under the curve of frail score to judge PCSD was significantly larger than the other independent influencing factors of PCSD.Conclusions Preoperative frailty status can be used to assess the risk of delirium during hospitalization in adult patients after cardiac surgery. It is helpful for early risk stratification and guidance of precise intervention.