Grabowska Izabela, Ścisło Lucyna, Pietruszka Szymon, Walewska Elzbieta, Paszko Agata, Siarkiewicz Benita, Richter Piotr, Budzyński Andrzej, Szczepanik Antoni M
Jagiellonian University Medical College of Carcow, Poland: Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine.
Jagiellonian University Medical College of Carcow, Poland: Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Care.
Pol Merkur Lekarski. 2017 Apr 21;42(250):151-157.
Demographic changes in contemporary society require implementation of proper perioperative care of elderly patients due to an increased risk of perioperative complications in this group. Preoperative assessment of health status identifies risks and enables preventive interventions, improving outcomes of surgical treatment. The Comprehensive Geriatric Assessment contains numerous diagnostic tests and consultations, which is expensive and difficult to use in everyday practice. The development of a simplified model of perioperative assessment of elderly patients will help identifying the group of patients who require further diagnostic workup.
The aim of the study is to evaluate the usefulness of the tests used in a proposed model of perioperative risk assessment in elderly patients.
In a group of 178 patients older than 64 years admitted for surgical procedures, a battery of tests was performed. The proposed model of perioperative risk assessment included: Charlson Comorbidity Index, ADL (activities of daily living), TUG test (timed "up and go" test), MNA (mini nutritional assessment), AMTS (abbreviated mental test score), spirometry measurement of respiratory muscle strength (Pimax, Pemax). Distribution of abnormal results of each test has been analysed.
The Charlson Index over 6 points was recorded in 10.1% of patients (15.1% in cancer patients). Abnormal result of the TUG test was observed in 32.1%. The risk of malnutrition in MNA test has been identified in 29.7% (39.2% in cancer patients).
Abnormal test results at the level of 10-30% indicate potential diagnostic value of Charlson Comorbidity Index, TUG test and MNA in the evaluation of perioperative risk in elderly patients.
当代社会的人口结构变化要求对老年患者实施适当的围手术期护理，因为该群体围手术期并发症的风险增加。术前健康状况评估可识别风险并进行预防性干预，从而改善手术治疗效果。综合老年评估包含众多诊断测试和会诊，费用高昂且难以在日常实践中应用。开发一种简化的老年患者围手术期评估模型将有助于识别需要进一步诊断检查的患者群体。
本研究的目的是评估所提出的老年患者围手术期风险评估模型中所使用测试的有效性。
对178例64岁以上接受外科手术的患者进行了一系列测试。所提出的围手术期风险评估模型包括：查尔森合并症指数、日常生活活动能力（ADL）、定时起立行走测试（TUG测试）、微型营养评定（MNA）、简易精神状态检查表（AMTS）、呼吸肌力量的肺活量测定（最大吸气压、最大呼气压）。分析了每项测试异常结果的分布情况。
10.1%的患者查尔森指数超过6分（癌症患者中为15.1%）。32.1%的患者TUG测试结果异常。MNA测试中发现29.7%的患者存在营养不良风险（癌症患者中为39.2%）。
10%-30%水平的异常测试结果表明查尔森合并症指数、TUG测试和MNA在评估老年患者围手术期风险方面具有潜在诊断价值。
