老年人衰弱指数与结节性甲状腺肿住院患者围手术期并发症的相关性分析

摘要

目的 老年人衰弱指数(frailty index,FI)与结节性甲状腺肿住院患者围手术期并发症的相关性分析.方法 选择结节性甲状腺肿老年患者120例,依据患者术前FI分为无衰弱组(FI<0.08,35例)、轻度衰弱组(FI ≥0.08~0.25,35例)、衰弱组(FI>0.25,50例).比较各组美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、住院时间和术后并发症发生情况,并分析其与FI的相关性.结果 3组ASA分级比较差异无统计学意义(P>0.05).Spearman相关性分析结果显示患者FI与ASA分级具有一定的相关性,但相关性临床意义不大(rs=0.265,P=0.007).3组并发症发生率和住院时间比较差异有统计学意义(P<0.05);衰弱组并发症发生率高于无衰弱组(P<0.05);轻度衰弱组和衰弱组住院时间长于无衰弱组,衰弱组住院时间长于轻度衰弱组(P<0.05).Spearman相关性分析结果显示FI与围术期并发症呈正相关(rs=0.519,P=0.023).FI预测结节性甲状腺肿外科切除术围术期并发症的ROC曲线面积为0.812(95% CI:0.699~0.882,P=0.000).结论 老年人FI过高是结节性甲状腺肿住院患者围手术期并发症发生的重要预测指标,术前对结节性甲状腺肿老年患者进行FI评分有助于为临床诊疗提供合理依据,降低术后并发症发生率.%Objective To explore the correlation between frailty index and postoperative complications of aged patients with nodular goiter, in order to provide reference evidence for clinical care.Methods One hundred and twenty cases aged patients with ndular goiter undergoing operative treatment were selected as the research object.All of them were divided into three groups according to the frailty index as follows:nonfrail group(FI<0.08, 35 cases), intermediately frail group(FI≥0.08-0.25, 35 cases) and frail group(FI>0.25, 50 cases).Collect clinical data of patients about general data, BMI, ASA classification, hospital stays and postoperative complications were examined.The correlation between the indexes above and frailty index was analysed.Results There was no significant difference between the 3 groups in the ASA classification(P>0.05).Frailty index and the ASA classification has some relevance, but less relevant according to the Spearman correlation analysis( rs=0.265, P=0.007 ).There was significant difference among the 3 groups in the incidence of complications and hospitalization time (P<0.05).The incidence of complications in the frail group was higher than that in the nonfrail group(P<0.05).The hospitalization time of intermediately frail group and frail group was longer than that of non weak group.The hospitalization time of the frail group was longer than that of the intermediately frail group(P<0.05).Spearman correlation analysis showed that FI was positively correlated with perioperative complications(rs=0.519, P=0.023).FI predicts that the ROC curve area of perioperative complications of surgical resection of nodular goiter is 0.812(CI:0.699-0.882, P=0.000).Conclusion The level of frailty index is risk factor of postoperative complications of aged patients with nodular goiter.The preoperative frailty index evaluation can provide reference evidence for the treatment of aged NG patients undergoing surgery with low postoperative complications rate.