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

摘要：

目的 分析老年腹部大手术患者围手术期肌肉状况的动态变化和其影响因素，为老年腹部大手术患者个性化护理方案的制订提供参考。 方法 采用便利抽样法，选取2023年1月—2024年1月北京市某三级甲等医院普通外科收治的行腹部大手术的164例老年患者作为调查对象，通过握力、步速、生物电阻抗分析评估老年腹部大手术患者在术前、术后1周、术后1个月时的肌肉状况，并使用群组轨迹模型拟合肌肉状况发展变化的潜在类别，采用多元Logistic回归分析不同组别的影响因素。 结果 共有147例患者完成研究，有效问卷回收率为89.63%。重复测量方差分析显示，老年腹部大手术患者3个时间点的肌肉状况差异均具有统计学意义（P<0.05）。术前至术后1个月，老年腹部大手术患者的肌肉状况变化存在稳定非肌少症组、潜在恢复肌少症组、快速恶化肌少症组3个类别。多元Logistic回归分析显示，年龄较大是老年腹部大手术患者肌少症进展的危险因素，BMI较大、Barthel指数得分较高、男性是老年腹部大手术患者肌肉状态稳定的保护因素（P<0.05）。 结论 老年腹部大手术患者术前至术后1个月的肌肉状况变化存在异质性，Barthel指数得分、BMI、年龄、性别是肌肉状况变化的重要预测因素，有必要针对高危人群进行分类护理和早期干预。

关键词: 老年人, 腹部大手术, 肌少症, 影响因素分析, 护理