关键词: 老年人, 腹部大手术, 肌少症, 影响因素分析, 护理

Abstract:

Objective To investigate the dynamic changes and influencing factors of perioperative muscle status in older patients undergoing major abdominal surgery，thereby providing a reference for developing individualized nursing care plans. Methods A convenience sample of 164 older patients undergoing major abdominal surgery in the Department of General Surgery at a tertiary hospital in Beijing was enrolled between January 2023 and January 2024. Muscle status was assessed preoperatively，at a week，and a month postoperatively using grip strength，gait speed，and bioelectrical impedance analysis. Group-based trajectory modeling（GBTM） was employed to identify latent classes of muscle status progression. Logistic regression analysis was used to examine the influencing factors across the different trajectory groups. Results Among the 147 elderly patients completing the study，and the effective response rate was 89.63%. Repeated measures ANOVA revealed statistically significant differences in sarcopenia status at 3 time points（P<0.05）. Totally 3 progression models were identified：stable non-sarcopenic group，potential recovery sarcopenic group，and rapid deterioration sarcopenic group. Multivariate analysis confirmed advanced age as risk factors for worsening sarcopenia，and conversely，higher BMI，and higher Barthel Index scores and male sex as protective factors（P<0.05）. Conclusion The study found that there was heterogeneity in the development of muscle condition from preoperative to 1 month after surgery in elderly patients with major abdominal surgery. Barthel Index，BMI，age，and sex were identified as significant predictors of sarcopenia progression. Therefore，implementing stratified nursing care and early interventions for high-risk groups is recommended.

Key words: Aged, Major Abdominal Surgery, Sarcopenia, Root Cause Analysis, Nursing Care