衰弱对老年肺癌患者术后谵妄、吸入性肺炎和短期预后的预测价值

Predictive value of frailty for postoperative delirium,aspiration pneumonia and short-term prognosis in elderly lung cancer patients

目的探讨衰弱对老年肺癌患者术后谵妄、吸入性肺炎和1年内死亡率的预测作用。方法选取2021年7月—2023年6月于空军军医大学第二附属医院行外科手术的老年肺癌患者159例,根据术前衰弱评分分为衰弱组(n=56)和非衰弱组(n=103)。采用单因素和多因素Logistic回归方法分析衰弱是否是预测患者术后谵妄、吸入性肺炎和1年内死亡的独立危险因素。结果与无衰弱组相比,衰弱组患者年龄更大、合并糖尿病比例更高、ASA分级ⅡⅢ级比例更、ECOG评分23分比例更高、输血比例更高(均P<0.05)。与无衰弱组相比,衰弱组患者术后谵妄(19.42%vs 37.50%,P=0.01)、吸入性肺炎(8.74%vs 19.64%,P=0.04)和1年内死亡率(17.48%vs 33.93%,P=0.02)均显著升高。单因素回归分析结果显示,合并糖尿病(OR=1.78,P=0.006)、手术时间长(OR=2.21,P=0.004)、肿瘤分期高(OR=1.48,P=0.03)、ECOG评分高(OR=2.05,P<0.001)及衰弱(OR=2.95,P=0.002)是影响老年肺癌患者术后谵妄、吸入性肺炎和1年内死亡的危险因素。多因素分析提示,合并糖尿病(OR=1.50,P=0.007)、肿瘤分期高(OR=1.88,P=0.01)、ECOG评分高(OR=2.90,P<0.001)和衰弱(OR=1.42,P=0.03)是老年肺癌患者术后谵妄、吸入性肺炎和1年内死亡的独立危险因素。结论合并衰弱的老年肺癌患者术后发生谵妄、吸入性肺炎和1年内死亡的风险可能增加,在临床上值得关注。

Objective To explore the predictive value of frailty on postoperative delirium,aspiration pneumonia and 1-year mortality rate in elderly lung cancer patients.Methods 159 elderly patients with lung cancer who underwent surgery in Second Affiliated Hospital of Air Force Medical University from July 2021 to June 2023 were selected and divided into frailty group(n=56)and non-frailty group(n=103)according to their preoperative frailty scores.Univariate and multivariate logistic regression methods were used to analyze whether frailty was an independent risk factor for predicting postoperative delirium,aspiration pneumonia,and death within 1 year.Results Compared with the non-frailty group,the patients in the frailty group were older,had a higher proportion of patients with diabetes,higher proportion of ASA gradeⅡⅢ,higher proportion of ECOG scores of 23,and higher proportion of blood transfusion(all P<0.05).Compared with the non-frailty group,the incidence of postoperative delirium(19.42%vs 37.50%,P=0.01)and aspiration pneumonia(8.74%vs 19.64%,P=0.04),as well as the 1-year mortality rate(17.48%vs 33.93%,P=0.02),increased significantly in the frailty group.Univariate regression analysis showed that comorbid diabetes(OR=1.78,P=0.006),long operation time(OR=2.21,P=0.004),high tumor stage(OR=1.48,P=0.03),high ECOG scores(OR=2.05,P<0.001),and frailty(OR=2.95,P=0.002)were risk factors for postoperative delirium,aspiration pneumonia and death within 1 year in elderly patients with lung cancer.Multivariate analysis suggested that comorbid diabetes(OR=1.50,P=0.007),high TNM stage(OR=1.88,P=0.01),high ECOG score(OR=2.90,P<0.001),and frailty(OR=1.42,P=0.03)were the independent risk factors for postoperative delirium,aspiration pneumonia,and 1-year mortality in elderly patients with lung cancer.Conclusion The risk of postoperative delirium,aspiration pneumonia and death within one year may increase in elderly lung cancer patients complicated with frailty,which deserves clinical attention.