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�
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
作者
缪雪怡
丁玲玉
陆金玲
胡洁蔓
朱涵菲
陈丽
徐欣怡
许勤
MIAO Xueyi;DING Lingyu;LU Jinling;HU Jieman;ZHU Hanfei;CHEN Li;XU Xinyi;XU Qin(School of Nursing,Nanjing Medical University,Nanjing 211166,China;Department of Gastric Surgery,the First Afiliated Hospital with Nanjing Medical University,Nanjing 210029,China)
出处
《中国全科医学》
CAS
北大核心
2023年第8期980-988,共9页
Chinese General Practice
基金
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)。
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
Stomach neoplasms
Castric cancer
Frailty
Aged
Tilburg Frailty Indicator
Quality of life
Adverse outcomes
Precision medicine
