三种衰弱评估方法对老年骨科患者术后谵妄的预测作用

Predictive V alue of Three Frailty Assessment Methods on Postoperative Delirium in Older Patients Undergoing Orthopedic Surgery

目的 比较FRAIL量表(FS)、临床衰弱量表(CFS)和自我报告的埃德蒙特衰弱量表(REFS)对老年骨科患者术后谵妄(POD)的预测作用。方法 选取2021年9月~2022年5月于江苏省人民医院接受骨科手术的252例老年患者作为研究对象,根据是否发生POD分为POD组(43例)和非POD组(209例)。采用单因素和多因素logistic回归分析来确定衰弱与POD的相关性,并绘制ROC曲线比较各衰弱量表对POD的预测价值。结果 单因素logistic回归分析显示,年龄、体型、文化程度、婚姻状况、脑血管疾病病史、ADL评分、营养状况、认知水平、低蛋白血症、贫血、术中输血、FS结果、CFS结果、REFS结果是POD的影响因素(P<0.05)。将单因素分析结果中差异有统计学意义的指标作为自变量带入多因素logistic回归分析,排除混杂因素影响后,REFS评估的衰弱仍是POD的独立危险因素(P<0.05),REFS预测POD的ROC曲线下面积为0.804(95%CI:0.723~0.885)。结论 对于骨科老年患者,REFS评估的衰弱与术后谵妄之间存在显著的相关性,且REFS对POD的预测价值较高。

Objective To compare the predictive value of the Frail Scale(FS),Clinical Frailty Scale(CFS),and Reported Edmonton Frail Scale(REFS)on postoperative delirium(POD)in older patients undergoing orthopedic surgery.Methods A total of 252 older patients undergoing orthopedic surgery in Jiangsu Province Hospital between September 2021 and May 2022 were enrolled in this study.According to the postoperative outcome,the patients were divided into a POD group(43 cases)and non-POD group(209 cases).Univariate and multivariate logistic regression were used to analyze the correlation between preoperative frailty with POD.The receiver operating characteristic(ROC)curve was used to compare the predictive value of each frailty scale on POD.Results Univariate logistic regression analysis suggested age,body shape,literacy,marital status,cerebrovascular disease,activity of daily living(ADL)score,nutritional status,cognitive level,hypoalbuminemia,anemia,intraoperative blood transfusion,FS,score,CFS score,and REFS score were the influential factors for POD(P<0.05).Multivariate logistic regression analysis suggested that frailty evaluated by REFS remained an independent risk factor for POD(P<0.05).The area under the ROC curve of REFS was 0.804(95%CI:0.723~0.885).Conclusion For older patients undergoing orthopedic surgery,frailty evaluated by REFS is significantly associated with POD,and REFS score shows high predictive value for POD.