肺移植患者衰弱变化轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2023.09.010

摘要/Abstract

摘要：

目的探讨肺移植患者从肺移植手术前到术后1年的衰弱现状及变化轨迹，并分析其影响因素。方法采用前瞻性研究设计，便利抽样法选取无锡市某三级甲等医院收治的2019年7月—2020年12月符合标准的肺移植患者，收集患者的社会人口学资料和临床资料，使用简易体能状况量表和Fried衰弱表型量表分别在手术前1周（T1）、术后2周（T2）、术后1个月（T3）、术后3个月（T4）、术后6个月（T5）及术后1年（T6）对患者进行衰弱评估，并收集患者的相关营养及运动指标。建立线性混合效应模型识别轨迹类别，采用二分类Logistic回归模型进行衰弱轨迹的影响因素分析。结果 T1纳入190例，T2~T6分别失访17、9、12、15、16例，最终纳入121例，T1~T6患者的简易体能状况量表评分分别为（7.93±3.30）、（5.65±3.40）、（9.22±2.95）、（10.69±2.59）、（11.06±2.57）、（11.36±2.20）分，Fried衰弱表型量表评分分别为（3.32±1.21）、（3.74±1.01）、（2.81±1.11）、（1.86±1.23）、（1.54±1.16）、（1.11±1.14）分。二分类Logistic回归分析显示，年龄、ICU入住时间、术后住院时间、术后并发症数量、首次下床时间、手术方式和文化程度是肺移植患者术后衰弱变化轨迹的影响因素。结论肺移植患者衰弱在肺移植术后逐渐好转，临床应重视年龄大、并发症多、住院时间长的肺移植患者的衰弱评估，制订具有针对性的术前预康复以及术后快速康复策略。

关键词: 肺移植, 衰弱, 轨迹, 影响因素分析, 纵向研究, 护理

Abstract:

Objective To investigate the status and trajectory of frailty among lung transplantation patients from preoperation to 1 year after operation，and to analyze the predictive role of demographic and disease-related factors on the change trajectory of frailty. Methods A prospective study design was used. Lung transplant patients who met the criteria and were admitted to a tertiary A hospital in Wuxi City from July 2019 to December 2020 were selected by convenience sampling method，and the socio-demographic and clinical data of patients were collected. The frailty of patients was assessed by the Short Physical Performance Battery（SPPB） and Fried Frailty Phenotype（FFP） at 1 week before operation（T1），2 weeks after operation（T2），1 month after operation（T3），3 months after operation（T4），6 months after operation（T5） and 1 year after operation（T6），and the related nutritional and exercise indexes were collected. The linear mixed effect model was established to identify the track categories，and the binomial classification Logistic regression model was used to analyze the influencing factors of the frailty score track. Results 190 cases were included in T1 stage；17，9，12，15，16 cases were lost for follow-up in T2~T6 stage；121 cases were finally included. The SPPB scores of T1-T6 patients were（7.93±3.30），（5.65±3.40），（9.22±2.95），（10.69±2.59），（11.06±2.57），（11.36±2.20）， respectively. The FFP scores were（3.32±1.21），（3.74±1.01），（2.81±1.11），（1.86±1.23），（1.54±1.16），（1.11±1.14）， respectively. Univariate binomial logistic regression analysis showed that age，time of ICU stay，time of postoperative hospital stay，number of postoperative complications，first time out of bed，operation and education method were the influencing factors of frailty trajectory in lung transplantation patients. Conclusion Frailty of lung transplantation patients is gradually improved after lung transplantation. Clinical attention should be paid to the frailty assessment of lung transplantation patients with old age，more complications and long hospital stay，so as to develop targeted preoperative rehabilitation and postoperative rapid rehabilitation strategies.

Key words: Lung Transplantation, Frailty, Trajectory, Root Cause Analysis, Longitudinal Studies, Nursing Care

黄珂瑶, 丁思妍, 周海琴, 蔡英华. 肺移植患者衰弱变化轨迹及影响因素研究[J]. 中华护理杂志, 2023, 58(9): 1088-1095.

HUANG Keyao, DING Siyan, ZHOU Haiqin, CAI Yinghua. Study on the frailty trajectory and influencing factors of lung transplantation patients[J]. Chinese Journal of Nursing, 2023, 58(9): 1088-1095.

图/表 9

表1 调查对象的一般资料[n=121，例（百分比，%）]

Table 1 General information of the respondents[n=121，cases（percentages，%）]

表2 调查对象不同时间点营养运动指标及衰弱评分（$\bar{x}±s$）

Table 2 Nutrition and exercise indexes and frailty scores at different stages of T1~T6（$\bar{x}±s$）

表3 自变量赋值方式

Table 3 Variable assignment method

表4 简易体能状况评分的影响因素分析

Table 4 Analysis of influencing factors of SPPB score

表5 衰弱身体表型评分的影响因素分析

Table 5 Analysis of influencing factors of FFP score

图1 简易体能状况衰弱轨迹

Figure 1 Short Physical Performance Battery weakening trajectory

图2 Fried衰弱表型轨迹

Figure 2 Fried Frailty Phenotype trajectory

表6 简易体能状况评分轨迹的影响因素分析

Table 6 Analysis of influencing factors of SPPB score trajectory

表7 Fried衰弱表型评分轨迹的影响因素分析

Table 7 Analysis of influencing factors of FFP score trajectory

参考文献 26

[1]	Halpern AL, Boshier PR, White AM, et al. A comparison of frailty measures at listing to predict outcomes after lung transplantation[J]. Ann Thorac Surg, 2020, 109(1):233-240. DOI PMID
[2]	Venado A, McCulloch C, Greenland JR, et al. Frailty trajectories in adult lung transplantation:a cohort study[J]. J Heart Lung Transplant, 2019, 38(7):699-707. DOI URL
[3]	Venado A, Kolaitis NA, Huang CY, et al. Frailty after lung trans-plantation is associated with impaired health-related quality of life and mortality[J]. Thorax, 2020, 75(8):669-678. DOI PMID
[4]	Schaenman JM, Diamond JM, Greenland JR, et al. Frailty and aging-associated syndromes in lung transplant candidates and recipients[J]. Am J Transplant, 2021, 21(6):2018-2024. DOI PMID
[5]	Kobashigawa J, Dadhania D, Bhorade S, et al. Report from the American Society of Transplantation on frailty in solid organ transplantation[J]. Am J Transplant, 2019, 19(4):984-994. DOI PMID
[6]	Lee YK, Shukman M, Biniwale R, et al. Benefits of both physical assessment and electronic health record review to assess frailty prior to heart transplant[J]. Clin Transplant, 2022, 36(3):e14559.
[7]	蒋知俭. 统计分析在医学课题中的应用[M]. 北京: 人民卫生出版社, 2008.
	Jiang ZJ. Application of statistical analysis in medical subjects[M]. Beijing: People’s Medical Publishing House, 2008.
[8]	Guralnik JM, Simonsick EM, Ferrucci L, et al. A short physical performance battery assessing lower extremity function:association with self-reported disability and prediction of mortality and nursing home admission[J]. J Gerontol, 1994, 49(2):M85-M94. DOI URL
[9]	Singer JP, Diamond JM, Gries CJ, et al. Frailty phenotypes,disability,and outcomes in adult candidates for lung transplantation[J]. Am J Respir Crit Care Med, 2015, 192(11):1325-1334. DOI URL
[10]	Jha SR, Hannu MK, Gore K, et al. Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation[J]. J Heart Lung Transplant, 2016, 35(9):1092-1100. DOI URL
[11]	Smith PJ, Blumenthal JA, Carney RM, et al. Neurobehavioral functioning and survival following lung transplantation[J]. Chest, 2014, 145(3):604-611. DOI PMID
[12]	Fried LP, Tangen CM, Walston J, et al. Frailty in older adults:evidence for a phenotype[J]. J Gerontol Ser A Biol Sci Med Sci, 2001, 56(3):M146-M157. DOI URL
[13]	McAdams-DeMarco MA, Law A, King E, et al. Frailty and mortality in kidney transplant recipients[J]. Am J Transplant, 2015, 15(1):149-154. DOI PMID
[14]	吴珍珍, 张瑞, 常艳, 等. 衰弱表型和衰弱筛查量表在老年住院患者中的应用比较[J]. 中华护理杂志, 2021, 56(5):673-679. DOI
	Wu ZZ, Zhang R, Chang Y, et al. Application comparison of Frailty Phenotype and FRAIL Scale in frailty risk screening of elderly inpatients[J]. Chin J Nurs, 2021, 56(5):673-679. DOI
[15]	Pizov R. The body mass index,airflow obstruction,dyspnea,and exercise capacity index in chronic obstructive pulmonary disease[J]. Surv Anesthesiol, 2004, 48(6):282-283. DOI URL
[16]	刘子嘉, 张路, 刘洪生, 等. 基于加速术后康复的胸外科手术预康复管理专家共识(2022)[J]. 协和医学杂志, 2022, 13(3):387-401.
	Liu ZJ, Zhang L, Liu HS, et al. Expert consensus on pre-habilitation management for enhanced recovery in patients undergoing thoracic surgery(2022)[J]. Med J Peking Union Med Coll Hosp, 2022, 13(3):387-401.
[17]	Schneeberger T, Jarosch I, Leitl D, et al. Effects of a comprehensive pulmonary rehabilitation(PR)-program on frailty in lung transplantation candidates-a prospective observational study[C]// Rehabilitation and chronic care. European Respiratory Society, 2020.
[18]	胡春晓, 李小杉, 卫栋, 等. 前进中的肺移植事业:我国肺移植发展现状及未来[J]. 器官移植, 2020, 11(2):204-207.
	Hu CX, Li XS, Wei D, et al. The development of lung transplantation:current situation and future of lung transplantation in China[J]. Organ Transplant, 2020, 11(2):204-207.
[19]	马丽娜. 老年衰弱综合征的发病机制[J]. 中华老年医学杂志, 2021, 40(3):379-382.
	Ma LN. The pathogenesis of senile frailty syndrome[J]. Chin J Geriatr, 2021, 40(3):379-382.
[20]	张洁, 张丹丹, 王海妍. 衰弱老年人非药物干预的研究进展[J]. 中华护理杂志, 2020, 55(10):1588-1593. DOI
	Zhang J, Zhang DD, Wang HY. Research progress on non-pharmacological interventions for the frail elderly[J]. Chin J Nurs, 2020, 55(10):1588-1593. DOI
[21]	Sündermann S, Dademasch A, Praetorius J, et al. Comprehensive assessment of frailty for elderly high-risk patients undergoing cardiac surgery[J]. Eur J Cardiothorac Surg, 2011, 39(1):33-37. DOI PMID
[22]	方幸, 徐建鸣. 老年心脏手术患者衰弱评估及安全管理研究进展[J]. 中华护理杂志, 2019, 54(2):206-210. DOI
	Fang X, Xu JM. Research progress on the assessment and safety management of frailty in elderly cardiac surgery patients[J]. Chin J Nurs, 2019, 54(2):206-210.
[23]	McAdams-DeMarco MA, Ying H, Olorundare I, et al. Individual frailty components and mortality in kidney transplant recipients[J]. Transplantation, 2017, 101(9):2126-2132. DOI PMID
[24]	Olbrisch ME, Benedict SM, Ashe K, et al. Psychological assessment and care of organ transplant patients[J]. J Consult Clin Psychol, 2002, 70(3):771-783. DOI PMID
[25]	孙绪红, 蔡英华, 朱雪芬, 等. 肺移植病人家属心理护理研究进展[J]. 护理研究, 2021, 35(4):679-681.
	Sun XH, Cai YH, Zhu XF, et al. Research progress on psychological nursing of family members of patients with lung transplantation[J]. Chin Nurs Res, 2021, 35(4):679-681.
[26]	周海琴, 黄珂瑶, 闵群惠, 等. 肺移植术后主要照顾者照顾知信行调查及影响因素分析[J]. 护理研究, 2022, 36(16):2880-2885.
	Zhou HQ, Huang KY, Min QH, et al. Investigation and influencing factors analysis of caring knowledge,belief,and behavior of primary caregivers of patients after lung transplantation[J]. Chin Nurs Res, 2022, 36(16):2880-2885.