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衰弱对老年创伤性颅脑损伤患者短期神经功能预后的影响

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目的 探讨衰弱对老年创伤性颅脑损伤患者短期神经功能预后的影响.方法 选取2019年4月-2022年4月海安市人民医院收治的127例老年创伤性颅脑损伤患者进行回顾性分析.收集患者的一般信息、人口学特征、临床指标以及影像学检查报告等.临床衰弱量表对患者有无衰弱及严重程度进行评估.比较衰弱组和无衰弱组院内死亡率和发病3个月时的神经功能状态.使用多因素logistic回归模型分析影响患者神经功能预后的因素,并通过ROC曲线明确Glasgow昏迷评分和logistic回归模型对神经功能预后的预测效能.结果 127例老年创伤性颅脑损伤患者中48例存在衰弱.住院期间死亡34例,发病3个月时神经功能预后不良63例.同非衰弱组相比,衰弱组年龄更大、住院期间死亡率更高,且发病3个月时神经功能预后不良比例更高(P<0.05).多因素logistic回归分析显示:年龄>75岁、高Glasgow昏迷评分以及临床衰弱评分≥5分是老年创伤性颅脑损伤患者发病3个月时神经功能预后不良的独立危险因素(P<0.05).ROC曲线结果显示:Glasgow昏迷评分预测老年创伤性颅脑损伤患者发病3个月时神经功能预后不良的曲线下面积为0.643(95%CI:0.532~0.727),而综合年龄、Glasgow昏迷评分以及临床衰弱评分组成的多元回归方程对应曲线下面为0.874(95%CI:0.782~0.931).结论 合并衰弱的老年创伤性颅脑损伤患者死亡率高,预后不佳,值得临床关注.
Effect of frailty on the short-term functional outcome of elderly patients with traumatic brain injury
Objective To investigate the effect of frailty on the short-term functional outcome of elderly patients with trau-matic brain injury.Methods A retrospective analysis was conducted on 127 elderly patients with traumatic brain injury admitted to Hai'an People's Hospital from April 2019 to April 2022.General information,demographics,clinical indicators and imaging results were collected.The clinical frailty scale that provides an assessment of the presence and severity of frailty was applied.The in-hospital mortality and neurological status at 3 months of onset were compared between the frail and non-frail groups.Multivariate logistic regres-sion were used to clarify the factors affecting the prognosis of patients'neurological function,and clarify the predictive power of Glasgow coma scale and logistic regression model for neurological function prognosis through ROC curve analysis.Results Among the 127 eld-erly patients with traumatic brain injury,48 cases had frailty.A total of 34 patients died during hospitalization,and 63 patients had poor neurological outcome at 3 months follow-up.Compared with the non-frailty group,the frailty group was older,had a higher mortali-ty rate during hospitalization,and had a higher proportion of poor neurological prognosis at 3 months after onset(P<0.05).Multivari-ate logistics regression analysis shows that age>75 years old,higher Glasgow coma score and clinical frailty score ≥5 were independ-ent risk factors for poor neurological prognosis in elderly patients with traumatic brain injury at 3 months onset.The results of the ROC curve indicated that the area under the curve of the Glasgow coma score predicting poor neurological prognosis in elderly patients with traumatic brain injury at 3 months after onset was 0.643(95%CI:0.532-0.727),which was increased to 0.874(95%CI:0.782-0.931)when indicators of patient age,Glasgow coma score and clinical frailty score were applied.Conclusion Elderly traumatic brain injury patients with frailty have higher mortality and unfavorable prognosis that deserves clinical attention.

FrailtyTraumatic brain injuryShort-term functional outcome

顾玉晶、崔慧琴、顾阳、刘小江

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海安市人民医院创伤外科,海安 226600

海安市人民医院神经外科,海安 226600

衰弱 创伤性脑损伤 短期神经功能预后

2025

国际老年医学杂志
吉林大学

国际老年医学杂志

影响因子:0.435
ISSN:1674-7593
年,卷(期):2025.46(1)