心脏手术患者衰弱发展轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.02.001

摘要/Abstract

摘要：

目的探讨心脏手术患者术前至术后6个月衰弱的变化轨迹，分析其影响因素。方法采用纵向研究设计、便利抽样法，选取2022年8月—2023年6月遵义市某三级甲等综合医院择期行心脏瓣膜置换或冠状动脉旁路移植的患者作为研究对象，在术前1天（T0）、术后1个月（T1）、术后3个月（T2）、术后6个月（T3）使用中文版Tilburg衰弱评估量表评估心脏手术患者的衰弱水平。采用增长混合模型识别轨迹类别，运用二元Logistic回归分析不同衰弱轨迹的影响因素。结果 T0纳入261例，T1~T3分别失访22、9、3例，最终纳入227例。共识别出低衰弱下降组和高衰弱维持组2种衰弱发展轨迹。年龄、使用镇静镇痛药物种类、步速、是否抑郁是心脏手术患者衰弱的影响因素（P<0.05）。结论心脏手术患者存在2种衰弱发展轨迹，医护人员应针对衰弱的影响因素制订精准的护理措施，以改善心脏手术患者衰弱程度，提高其生活质量。

关键词: 心脏手术, 衰弱, 发展轨迹, 影响因素分析, 护理

Abstract:

Objective To explore the potential categories of frailty development trajectories in patients undergoing cardiac surgery from pre-operation to 6 months post-operation，and analyze the influencing factors. Methods By a longitudinal study design，patients undergoing elective heart valve replacement surgery or coronary artery bypass grafting in a tertiary general hospital in Zunyi City from August 2022 to June 2023 were selected by the convenience sampling method. Tilburg frailty scale was used to investigate the frailty level of cardiac surgery patients 1 day before surgery（T0），1 month（T1），3 months（T2） and 6 months after surgery（T3）. The growth mixture model was used to identify the trajectory categories，and the influencing factors of different frailty trajectories were analyzed by binary Logistic regression. Results 261 patients were enrolled at T0，with 22，9，and 3 patients lost at T1 to T3，and 227 patients were finally included in the analysis. There were 2 types of trajectories being identified as the low frailty decline group and the high frailty maintenance group. Age，use of sedative and analgesic drugs，pace，and depression were the factors influencing the frailty in cardiac surgery patients（P<0.05）. Conclusion There are 2 kinds of frailty development trajectories in patients undergoing cardiac surgery. Medical staff should formulate precise interventions and nursing measures according to the factors influencing frailty，so as to improve frailty degree and quality of life of patients undergoing cardiac surgery.

Key words: Cardiac Surgery, Frailty, Development Trajectory, Root Cause Analysis, Nursing Care

张临雪, 周家梅, 杨萍萍, 张金波, 罗明先, 李秀毛, 李珊, 曾璐. 心脏手术患者衰弱发展轨迹及影响因素研究[J]. 中华护理杂志, 2025, 60(2): 133-141.

ZHANG Linxue, ZHOU Jiamei, YANG Pingping, ZHANG Jinbo, LUO Mingxian, LI Xiumao, LI Shan, ZENG Lu. Study on the development trajectory and influencing factors of frailty in patients undergoing cardiac surgery[J]. Chinese Journal of Nursing, 2025, 60(2): 133-141.

图/表 7

表1 心脏手术患者衰弱发展轨迹的单因素分析

Table 1 Univariate analysis of the trajectory of frailty in patients undergoing cardiac surgery

表2 各时间点心脏手术患者衰弱发生率及中文版Tilburg衰弱评估量表得分

Table 2 Incidence of frailty and the score of Tilburg Frailty Index at each time point in patients undergoing cardiac surgery

表3 心脏手术患者衰弱各变化趋势占比及不同时间点中文版Tilburg衰弱评估量表得分（n=227）注：T0~T3分别代表术前1天、术后1个月、术后3个月、术后6个月。

Table 3 Trajectory in frailty of patients undergoing cardiac surgery and the score of Tilburg Frailty Index at different time points（n=227）

图1 心脏手术患者衰弱变化趋势图

Figure 1 Development trajectory of frailty in patients undergoing cardiac surgery

表4 心脏手术患者衰弱发展轨迹亚组拟合结果（n=227）

Table 4 Results of subgroup fitting of frailty development trajectory in cardiac surgery patients（n=227）

图2 心脏手术患者衰弱异质性发展轨迹图

Figure 2 Development trajectory of frailty heterogeneity in patients undergoing cardiac surgery

表5 心脏手术患者衰弱发展轨迹影响因素的二元Logistic回归分析（n=227）

Table 5 Binary Logistic regression analysis of factors influencing the trajectory of frailty development in cardiac surgery patients（n=227）

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