肺移植患者衰弱变化轨迹及影响因素研究

Study on the frailty trajectory and influencing factors of lung transplantation patients

目的探讨肺移植患者从肺移植手术前到术后1年的衰弱现状及变化轨迹,并分析其影响因素。方法采用前瞻性研究设计,便利抽样法选取无锡市某三级甲等医院收治的2019年7月—2020年12月符合标准的肺移植患者,收集患者的社会人口学资料和临床资料,使用简易体能状况量表和Fried衰弱表型量表分别在手术前1周(T1)、术后2周(T2)、术后1个月(T3)、术后3个月(T4)、术后6个月(T5)及术后1年(T6)对患者进行衰弱评估,并收集患者的相关营养及运动指标。建立线性混合效应模型识别轨迹类别,采用二分类Logistic回归模型进行衰弱轨迹的影响因素分析。结果T1纳入190例,T2~T6分别失访17、9、12、15、16例,最终纳入121例,T1~T6患者的简易体能状况量表评分分别为(7.93±3.30)、(5.65±3.40)、(9.22±2.95)、(10.69±2.59)、(11.06±2.57)、(11.36±2.20)分,Fried衰弱表型量表评分分别为(3.32±1.21)、(3.74±1.01)、(2.81±1.11)、(1.86±1.23)、(1.54±1.16)、(1.11±1.14)分。二分类Logistic回归分析显示,年龄、ICU入住时间、术后住院时间、术后并发症数量、首次下床时间、手术方式和文化程度是肺移植患者术后衰弱变化轨迹的影响因素。结论肺移植患者衰弱在肺移植术后逐渐好转,临床应重视年龄大、并发症多、住院时间长的肺移植患者的衰弱评估,制订具有针对性的术前预康复以及术后快速康复策略。

Objective To investigate the status and trajectory of frailty among lung transplantation patients from preoperation to 1 year after operation,and to analyze the predictive role of demographic and disease-related factors on the change trajectory of frailty.Methods A prospective study design was used.Lung transplant patients who met the criteria and were admitted to a tertiary A hospital in Wuxi City from July 2019 to December 2020 were selected by convenience sampling method,and the socio-demographic and clinical data of patients were collected.The frailty of patients was assessed by the Short Physical Performance Battery(SPPB)and Fried Frailty Phenotype(FFP)at 1 week before operation(T1),2 weeks after operation(T2),1 month after operation(T3),3 months after operation(T4),6 months after operation(T5)and 1 year after operation(T6),and the related nutritional and exercise indexes were collected.The linear mixed effect model was established to identify the track categories,and the binomial classification Logistic regression model was used to analyze the influencing factors of the frailty score track.Results 190 cases were included in T1 stage;17,9,12,15,16 cases were lost for follow-up in T2~T6 stage;121 cases were finally included.The SPPB scores of T1-T6 patients were(7.93±3.30),(5.65±3.40),(9.22±2.95),(10.69±2.59),(11.06±2.57),(11.36±2.20),respectively.The FFP scores were(3.32±1.21),(3.74±1.01),(2.81±1.11),(1.86±1.23),(1.54±1.16),(1.11±1.14),respectively.Univariate binomial logistic regression analysis showed that age,time of ICU stay,time of postoperative hospital stay,number of postoperative complications,first time out of bed,operation and education method were the influencing factors of frailty trajectory in lung transplantation patients.Conclusion Frailty of lung transplantation patients is gradually improved after lung transplantation.Clinical attention should be paid to the frailty assessment of lung transplantation patients with old age,more complications and long hospital stay,so as to develop targeted preoperative rehabilitation and postoperative rapid rehabilitation strategies.