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护理学报 ›› 2022, Vol. 29 ›› Issue (20): 1-5.doi: 10.16460/j.issn1008-9969.2022.20.001

• 研究生园地 •    下一篇

衰弱对老年短暂性脑缺血发作患者预后的影响

邓颖a, 黄山a, 胡慧秀b, 孙超b   

  1. 北京医院 国家老年医学中心 中国医学科学院老年医学研究院 a.神经外科; b.护理部,北京 100730
  • 收稿日期:2022-07-21 发布日期:2022-11-08
  • 通讯作者: 孙超（1979-）,女,北京人,硕士,副主任护师,护理部主任。E-mail: sunchaobjyy@163.com
  • 作者简介:邓颖（1986-）,女,北京人,本科学历,硕士研究生在读,主管护师,护士长。
  • 基金资助:
    中央高水平医院临床科研业务费资助（BJ-2019-194）; 国家重点研发计划（2020YFC2008500）

Effect of Frailty on Prognosis in Elderly Patients with Transient Ischemic Attack

DENG Yinga, HUANG Shana, HU Hui-xiub, SUN Chaob   

  1. a.Dept.of Neurosurgery; b.Dept.of Nursing Administration, Beijing Hospital, National Center of Geriatrics, Institute of Geriatrics, Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2022-07-21 Published:2022-11-08

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摘要： 目的 探讨衰弱对老年短暂性脑缺血发作患者预后的影响,并分析影响其预后的危险因素。方法 本研究为前瞻性队列研究,选取2017年1月—2020年1月在北京某三级甲等医院神经外科诊治的老年短暂性脑缺血发作患者。依据是否合并衰弱,分为衰弱前期组（102例）、衰弱组（47例）和未合并衰弱的60例患者为对照组。随访24个月,主要观察指标为脑血管事件发生情况,包括全因死亡、再发短暂性脑缺血发作。应用Kaplan-Meier生存分析和Log-rank检验比较3组患者的预后情况。应用Cox比例风险回归模型分析脑血管事件的相关因素。结果 209例患者中,衰弱组和衰弱前期组的B型利钠肽均高于对照组（P<0.05）。随访2年中共发生33例（15.8%）脑血管事件,包括5例（2.4%）全因死亡,28例（13.4%）再发。Kaplan-Meier生存分析和Log-rank检验结果提示,衰弱组复发或死亡率显著高于对照组（χ2=3.883,P=0.049）。采用多因素Cox比例风险回归模型,结果显示衰弱和心房颤动可能是发生脑血管事件的危险因素。结论 衰弱可增加老年短暂性脑缺血发作患者的再发短暂性脑缺血发作的发生风险,且为脑血管事件的危险因素。

关键词: 衰弱, 短暂性脑缺血发作, 老年, 脑血管事件, 危险因素

Abstract: Objective To investigate the effect of frailty on the prognosis of elderly patients with transient ischemic attack (TIA) during 2-year follow-up and to analyze the risk factors of prognosis. Methods We conducted a longitudinal cohort study. Elderly patients with TIA who were treated in neurosurgery department of tertiary, grade-A hospital in Beijing from January 2017 to January 2020 were selected. According to whether combined with frailty or not, patients were divided into pre-frailty group (n=102), frailty group (n=47) and control group of 60 cases without frailty. After 24 months of follow-up, the main outcome indicators were the occurrence of cerebrovascular events, including all-cause death and recurrent TIA. Kaplan-meier survival analysis and log-rank test were used to compare the prognosis of the three groups. Cox proportional risk regression model was used to analyze the related factors of cerebrovascular events. Results In 209 patients, b-type natriuretic peptide in pre-frailty group and frailty group was higher than that in the control group (P<0.05). There were 33 cases (15.8%) of cerebrovascular events, including 5 cases (2.4%) of all-cause death and 28 cases (13.4%) of recurrence. Kaplan-meier survival analysis and log-rank test showed that the recurrence or mortality of frailty group was significantly higher than that of the control group (χ2=3.883, P=0.049). Multivariate Cox proportional risk regression model showed that frailty and atrial fibrillation were risk factors of cerebrovascular events. Conclusion Frailty can significantly increase the risk of recurrent TIA in elderly patients with TIA, and is a risk factor associated with cerebrovascular events.

Key words: frailty, transient ischemic attack, elderly, cerebrovascular events, risk factor

中图分类号: 

  • R473
[1] Ruiz JG, Dent E, Morley JE, et al.Screening for and Managing the Person with Frailty in Primary Care: ICFSR Consensus Guidelines[J]. J Nutr Health Aging, 2020,24(9):920-927. DOI:10.1007/s12603-020-1492-3.
[2] He B, Ma Y, Wang C, et al.Prevalence and Risk Factors for Frailty among Community-Dwelling Older People in China: A Systematic Review and Meta-Analysis[J]. J Nutr Health Aging,2019,23(5):442-450.DOI:10.1007/s12603-019-1179-9.
[3] Cesari M, Prince M, Thiyagarajan JA, et al.Frailty: An Emerging Public Health Priority[J].J Am Med Dir Assoc, 2016,17(3):188-192. DOI:10.1016/j.jamda.2015.12.016.
[4] Rashidi Pour Fard N, Amirabdollahian F, Haghighatdoost F. Dietary Patterns and Frailty:A Systematic Review and Meta-analysis[J]. Nutr Rev, 2019,77(7):498-513. DOI:10.1093/nutrit/nuz007.
[5] Taylor-Rowan M, Cuthbertson G, Keir R, et al.The Prevalence of Frailty Among Acute Stroke Patients, and Evaluation of Method of Assessment[J]. Clin Rehabil, 2019,33(10):1688-1696. DOI:10.1177/0269215519841417.
[6] 樊凡. 急性缺血性脑卒中患者衰弱状态及血清白蛋白与卒中后认知障碍的相关性研究[D].成都:成都医学院,2020.
[7] Seib CD, Rochefort H, Chomsky-Higgins K, et al.Association of Patient Frailty With Increased Morbidity After Common Ambulatory General Surgery Operations[J].JAMA Surg, 2018,153(2):160-168. DOI:10.1001/jamasurg.2017.4007.
[8] 彭斌, 吴波. 中国急性缺血性脑卒中诊治指南2018[J]. 中华神经科杂志,2018,51(9):666-682.DOI:10.3760/cma.j.issn.1006-7876.2018.09.004.
[9] 郝秋奎, 李峻, 董碧蓉,等. 老年患者衰弱评估与干预中国专家共识[J].中华老年医学杂志,2017,36(3):251-256. DOI: 10.3760/cma.j.issn.0254-9026.2017.03.007.
[10] 刘一松. 基于PASS及SAS软件的常用样本含量估计方法实现及部分方法比较研究[D].北京:中国人民解放军军事医学科学院,2016.
[11] Xue QL.The Frailty Syndrome: Definition and Natural History[J]. Clin Geriatr Med, 2011,27(1):1-15.DOI:10.1016/j.cger.2010.08.009.
[12] Sze S, Zhang J, Pellicori P, et al.Prognostic Value of Simple Frailty and Malnutrition Screening Tools in Patients with Acute Heart Failure Due to Left Ventricular Systolic Dysfunction[J]. Clin Res Cardiol, 2017,106(7):533-541. DOI:10.1007/s00392-017-1082-5.
[13] 张彩情, 洪华山. 衰老心血管事件链[J]. 中华老年医学杂志,2019, 38(10):1180-1184.DOI:10.3760/cma.j.issn.0254-9026.2019.10.029.
[14] Taylor-Rowan M, Keir R, Cuthbertson G, et al.Pre-Stroke Frailty Is Independently Associated With Post-Stroke Cognition: A Cross-Sectional Study[J].J Int Neuropsychol Soc,2019,25(5):501-506.DOI:10.1017/S1355617719000092.
[15] Evans NR, Wall J, To B, et al.Clinical Frailty Independently Predicts Early Mortality after Ischaemic Stroke[J]. Age Ageing, 2020, 49(4):588-591.DOI:10.1093/ageing/afaa004.
[16] Wardlaw JM, Smith C, Dichgans M.Small Vessel Disease: Mechanisms and Clinical Implications[J]. Lancet Neurol, 2019,18(7):684-696. DOI:10.1016/S1474-4422(19)30079-1.
[17] 中国老年医学学会高血压分会.老年人异常血压波动临床诊疗中国专家共识[J].中国心血管杂志,2017,22(1):1-11.DOI:10.3969/j.issn.1007-5410.2017.01.001.
[18] Ashar FN, Moes A, Moore AZ, et al.Association of Mito-chondrial DNA Levels with Frailty and All-cause Mortality[J].J Mol Med (Berl).2015,93(2):177-186.DOI:10.1007/s00109-014-1233-3.
[19] D'Mello MJ, Ross SA, Briel M, et al. Association between Shortened Leukocyte Telomere Length and Cardiometabolic Outcomes: Systematic Review and Meta-analysis[J]. Circ Cardiovasc Genet. 2015,8(1):82-90.DOI:10.1161/CIRCGENETICS.113.000485.
[20] 牛晓丹,张静,郭静波,等. 糖尿病患者衰弱危险因素的Meta分析[J]. 护理学报,2021,28(11):1-6.
[21] 卢舒颖,刘宁,廉民学. 糖尿病患者急性卒中后血糖监测及管理的最佳证据总结[J]. 护理学报,2021,28(15):42-47.
[22] Samson LD, Boots A, Verschuren W, et al.Frailty is Associated with Elevated CRP Trajectories and Higher Numbers of Neutrophils and Monocytes[J]. Exp Gerontol, 2019,125:110674. DOI:10.1016/j.exger.2019.110674.
[23] Yarla NS, Polito A, Peluso I.Effects of Olive Oil on TNF-α and IL-6 in Humans: Implication in Obesity and Frailty[J]. Endocr Metab Immune Disord Drug Targets, 2018,18(1):63-74. DOI:10.2174/1871530317666171120150329.
[24] Shi K, Tian DC, Li ZG, et al.Global Brain Inflammation in Stroke[J]. Lancet Neurol, 2019,18(11):1058-1066. DOI: 10.1016/S1474-4422(19)30078-X.
[25] 吴怡婷,邢云利,孙颖. 衰弱对于老年心房颤动患者抗凝决策的影响[J]. 中华老年多器官疾病杂志,2020,19(12):945-948.DOI:10.11915/j.issn.1671-5403.2020.12.216.
[26] 鞠爱鹏. 中国高龄老人虚弱现状及影响因素分析[D].吉林:吉林大学,2022.
[27] García García J, Roquer J, Serena J, et al.Carotid Intima-Media Thickness is Not Associated with Markers of Atherosclerosis in Stroke Patients[J]. J Stroke Cerebrovasc Dis,2016,25(5):1070-1075.DOI:10.1016/j.jstrokecerebrovasdis.2016.01.002.
[28] 康琳, 朱鸣雷, 刘晓红,等. 衰弱与老年人冠状动脉粥样硬化性心脏病的相关性研究[J]. 中华老年医学杂志,2015,34(9):951-955.
[29] 赵黎. 老年糖尿病合并衰弱患者护理管理方案的构建[D].兰州:兰州大学,2022.
[30] Frost R, Belk C, Jovicic A, et al.Health Promotion in Terventions for Community-dwelling Older People with Mild or Pre-frailty: A Systematic Review and Meta-analysis[J]. BMC Geriatr, 2017, 17(1):157.DOI:10.1186/s12877-017-0547-8.
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