基于老年综合评估的预康复在术前衰弱老年肺癌病人中的应用

Application of prehabilitation based on comprehensive geriatric assessment in elderly patients with lung cancer combined with preoperative frailty

目的探讨基于老年综合评估的预康复在术前衰弱老年肺癌病人中的应用效果。方法选择术前衰弱的老年肺癌病人88例,随机分为对照组和观察组,每组各44例。对照组接受术前常规诊疗,观察组术前接受常规诊疗和基于老年综合评估的预康复。比较2组术后恢复、躯体功能、营养和心理状况。结果观察组43例和对照组42例病人完成研究。观察组早期下地时间、胸引流管留置时间、引流量、术后住院时间、术后第3天恢复质量得分以及术后30 d FEV1、FVC、并发症发生率均优于对照组;术后30 d,观察组握力、步速、血白蛋白、前白蛋白和血红蛋白水平均高于对照组,医院焦虑抑郁量表总分、分量表得分均低于对照组(P<0.05)。结论基于老年综合评估的预康复有利于术前衰弱老年肺癌病人的围术期管理及术后恢复。

Objective To explore the effect of prehabilitation based on comprehensive geriatric assessment(CGA)in the elderly patients with lung cancer combined with preoperative frailty.Methods A total of 88 elderly patients with lung cancer combined with preoperative frailty were randomly divided into two groups,with 44 cases in each group.The control group received routine nursing,while the observation group received prehabilitation based on CGA before surgery additionally.The postoperative recovery,physical function,nutritional status and psychological status were assessed and compared between the two groups.Results A total of 43 patients in the observation group and 42 patients in the control group completed the study.The first time of getting out of bed,thoracic drainage tube retention time,amount of drainage fluid,postoperative hospital stay,the score of 15-item Quality of Recovery Scale on the 3rd day after surgery,the levels of forced expiratory volume in the first second(FEV1),forced vital capacity(FVC)on the 30th day after surgery and postoperative complications in 30 days in the observation group were significantly better than those in the control group(P<0.05).30 days after surgery,grip strength,walking speed,the levels of blood albumin,prealbumin and hemoglobin in the observation group were significantly higher than those in the control group.The scores of the Hospital Anxiety and Depression Scale in the observation group were significantly lower than those in the control group(all P<0.05).Conclusions Prehabilitation based on CGA is beneficial for perioperative management of the elderly patients with lung cancer combined with frailty,which can promote postoperative recovery.