中国全科医学 ›› 2023, Vol. 26 ›› Issue (08): 980-988.DOI: 10.12114/j.issn.1007-9572.2022.0740

所属专题: 衰弱最新文章合集 老年问题最新文章合集

• 专题研究·癌症衰弱 • 上一篇    下一篇

衰弱亚型对老年胃癌患者不良结局的影响研究

缪雪怡1, 丁玲玉1, 陆金玲2, 胡洁蔓1, 朱涵菲1, 陈丽2, 徐欣怡1, 许勤1,*()   

  1. 1.211166 江苏省南京市,南京医科大学护理学院
    2.210029 江苏省南京市,南京医科大学第一附属医院胃外科
  • 收稿日期:2022-09-05 修回日期:2022-11-23 出版日期:2023-03-15 发布日期:2022-11-25
  • 通讯作者: 许勤

  • 作者贡献: 缪雪怡、丁玲玉负责文章的数据整理、构思与设计,论文的撰写;陆金玲、胡洁蔓负责研究的可行性分析,论文的修订;朱涵菲、陈丽、徐欣怡负责研究的实施、数据处理,论文的撰写;许勤对文章整体负责、监督管理。
  • 基金资助:
    国家自然科学基金面上项目(82073407); 2021年江苏省重点研发计划(社会发展)(BE2021722); 江苏高校优势学科建设工程项目"护理学"(苏政办发〔2018〕87号)

Preoperative Frailty and Postoperative Adverse Outcomes among Elderly Patients with Gastric Cancer

MIAO Xueyi1, DING Lingyu1, LU Jinling2, HU Jieman1, ZHU Hanfei1, CHEN Li2, XU Xinyi1, XU Qin1,*()   

  1. 1. School of Nursing, Nanjing Medical University, Nanjing 211166, China
    2. Department of Gastric Surgery, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
  • Received:2022-09-05 Revised:2022-11-23 Published:2023-03-15 Online:2022-11-25
  • Contact: XU Qin

摘要: 背景 老年胃癌患者在生理、心理、社会等方面均存在较大的异质性,可能导致不同维度的衰弱发生,形成不同的衰弱亚型,其术前各衰弱亚型对术后不良结局的影响有待探讨。 目的 探究老年胃癌患者术前各衰弱亚型对不良结局(总并发症、住院时间延长、生活质量低下及失能)的影响。 方法 采用便利抽样法,于2021年3—10月选取南京医科大学第一附属医院胃外科404例老年胃癌患者为研究对象,在术前采用一般资料调查表、Tilburg衰弱量表对其进行调查,通过电子病历系统收集患者总并发症和住院时间,术后1个月通过电话随访收集生活质量和失能信息。采用单因素Logistic回归分析探讨老年胃癌患者不良结局的影响因素。调整潜在的混杂因素后,使用多因素Logistic回归分析探讨不同衰弱亚型对老年胃癌患者不良结局的影响。 结果 404例老年胃癌患者术前衰弱分为8个衰弱亚型:仅生理衰弱77例(19.1%)、仅心理衰弱78例(19.3%)、仅社会衰弱23例(5.7%)、生理与心理衰弱63例(15.6%)、生理与社会衰弱13例(3.2%)、心理与社会衰弱16例(4.0%)、多维衰弱(生理、心理与社会衰弱)15例(3.7%)、非衰弱119例(29.5%)。单因素Logistic回归分析结果显示,年龄为老年胃癌患者总并发症的影响因素〔OR=1.063,95%CI(1.021,1.106),P=0.003〕;药物服用史〔OR=1.549,95%CI(1.016,2.362),P=0.042〕、手术方式〔OR=2.103,95%CI(1.191,3.712),P=0.010〕为老年胃癌患者住院时间延长的影响因素;婚姻状况〔OR=4.611,95%CI(1.079,19.706),P=0.039〕、居住地为城市〔OR=1.614,95%CI(1.009,2.582),P=0.046〕、合并慢性病数量≥2种〔OR=1.694,95%CI(1.038,2.766),P=0.035〕为老年胃癌患者低生活质量的影响因素;居住地为城市〔OR=0.601,95%CI(0.390,0.926),P=0.021〕、药物服用史〔OR=1.663,95%CI(1.082,2.558),P=0.020〕、胃癌TNM分期Ⅲ期及以上〔OR=1.659,95%CI(1.017,2.706),P=0.043〕为老年胃癌患者失能的影响因素。多因素Logistic回归分析结果显示,调整年龄因素后,术前多维衰弱〔OR=5.344,95%CI(1.715,16.656),P=0.004〕为老年胃癌患者总并发症的影响因素;调整药物服用史、手术方式因素后,术前仅生理衰弱〔OR=2.048,95%CI(1.078,3.891),P=0.029〕、仅心理衰弱〔OR=2.077,95%CI(1.103,3.913),P=0.024〕、多维衰弱〔OR=8.321,95%CI(2.400,28.848),P<0.001〕为老年胃癌患者住院时间延长的影响因素;调整婚姻状况、居住地为城市、合并慢性病数量≥2种因素后,术前仅心理衰弱〔OR=2.620,95%CI(1.267,5.418),P=0.009〕、心理与社会衰弱〔OR=11.122,95%CI(3.253,38.028),P<0.001〕、多维衰弱〔OR=11.579,95%CI(2.835,47.302),P<0.001〕为老年胃癌患者低生活质量的影响因素。 结论 医护人员应关注老年胃癌患者的术前衰弱状况,将多维衰弱量表整合至术前临床评估中,并高度重视术前被评估为仅生理衰弱、仅心理衰弱、心理与社会衰弱及多维衰弱的患者,针对老年胃癌患者的具体情况,针对性地采取预康复干预措施,以预防不良结局的发生,改善其生活质量。

关键词: 胃肿瘤, 胃癌, 衰弱, 老年人, Tilburg衰弱量表, 生活质量, 不良结局, 精准医疗

Abstract:

Background

Due to great differences in physiological reserve, psychological status and social functioning, frailty in elderly patients with gastric cancer may present various subtypes. The relationship between preoperative frailty and postoperative adverse outcomes in them still remains to be further explored.

Objective

To explore the relationship between preoperative frailty subtypes and postoperative adverse outcomes〔total complications, prolonged length of stay (PLOS), low quality of life (QOL), and disability〕among elderly patients with gastric cancer.

Methods

From March to October 2021, 404 elderly gastric cancer patients were selected from Department of Gastric Surgery, the First Affiliated Hospital with Nanjing Medical University by convenience sampling. The General Demographic Data Questionnaire and Tilburg Frailty Indicator were used to collect demographics and frailty status before surgery. Total complications and PLOS were collected from the electronic medical records, and the status of disability and QOL were obtained using a telephone follow-up at one month after discharge. Univariate Logistic regression was performed to explore the influencing factors of postoperative adverse outcomes. Multivariate Logistic regression analysis was performed to analyze the association of preoperative frailty subtypes with postoperative adverse outcomes, with potential confounders adjusted.

Results

Two hundred and eighty-five cases were found with preoperative frailty, and the frailty subtypes in them were classified into eight classes: exclusive physical frailty〔77 (19.1%) 〕, exclusive psychological frailty〔78 (19.3%) 〕, exclusive social frailty〔23 (5.7%) 〕, physical and psychological frailty〔63 (15.6%) 〕, physical and social frailty〔13 (3.2%) 〕, psychological and social frailty〔16 (4.0%) 〕, multidimensional frailty (physical, psychological, and social frailty) 〔15 (3.7%) 〕. The other 119 (29.5%) cases had no preoperative frailty. In the univariate Logistic regression, age was the factor influencing total complications〔OR=1.063, 95%CI (1.021, 1.106), P=0.003〕. History of pharmacological treatment〔OR=1.549, 95%CI (1.016, 2.362), P=0.042〕and surgical approach〔OR=2.103, 95%CI (1.191, 3.712), P=0.010〕were the factors influencing PLOS. Marital status〔OR=4.611, 95%CI (1.079, 19.706), P=0.039〕, living in an urban area〔OR=1.614, 95%CI (1.009, 2.582), P=0.046〕, having at least two comorbidities〔OR=1.694, 95%CI (1.038, 2.766), P=0.035〕were the factors influencing postoperative low QOL. Living in an urban area〔OR=0.601, 95%CI (0.390, 0.926), P=0.021〕, history of pharmacological treatment〔OR=1.663, 95%CI (1.082, 2.558), P=0.020〕, and advanced TNM stages〔OR=1.659, 95%CI (1.017, 2.706), P=0.043〕were the factors influencing postoperative disability. In the multivariate Logistic regression, the preoperative multidimensional frailty was independently associated with total complications, with age adjusted〔OR=5.344, 95%CI (1.715, 16.656), P=0.004〕. The preoperative physical frailty〔OR=2.048, 95%CI (1.078, 3.891), P=0.029〕, preoperative psychological frailty〔OR=2.077, 95%CI (1.103, 3.913), P=0.024〕and preoperative multidimensional frailty〔OR=8.321, 95%CI (2.400, 28.848), P<0.001〕were independently associated with PLOS, with history of pharmacological treatment and surgical approach adjusted. Preoperative psychological frailty〔OR=2.620, 95%CI (1.267, 5.418), P=0.009〕, preoperative psychological and social frailty〔OR=11.122, 95%CI (3.253, 38.028), P<0.001〕and preoperative multidimensional frailty〔OR=11.579, 95%CI (2.835, 47.302), P<0.001〕were independently associated with postoperative low QOL, with marital status, living in an urban area, and having at least two comorbidities adjusted.

Conclusion

Medical professionals should pay attention to preoperative frailty prevalence in elderly gastric cancer patients, and assess preoperative frailty in these patients using tools with the multidimensional frailty scale included, and attach great importance to those with exclusive physical frailty, exclusive psychological frailty, psychological and social frailty, and multidimensional frailty before surgery. A targeted prerehabilitation intervention program can be delivered to those with preoperative frailty according to their subtypes of frailty to improve postoperative adverse outcomes and QOL.

Key words: Stomach neoplasms, Castric cancer, Frailty, Aged, Tilburg Frailty Indicator, Quality of life, Adverse outcomes, Precision medicine