1 Department of Nursing, National Taiwan University and National Taiwan University Hospital, Taiwan.
2 Department of Physical Medicine and Rehabilitation, Fu Jen Catholic University Hospital and Fu Jen Catholic University School of Medicine, Taiwan.
Eur J Cardiovasc Nurs. 2019 Apr;18(4):309-317. doi: 10.1177/1474515118822964. Epub 2019 Feb 7.
Sarcopenia is linked with poor postoperative outcomes.
To evaluate the effects of sarcopenia on first-year functional changes after cardiac surgery.
In this prospective cohort study, functional changes (physical activity levels in metabolic equivalent hours/week, 6-minute walking distance in metres, and grip strength in kg) from preoperative baseline to 1, 3, 6 and 12 months postoperatively were compared in adult patients with and without sarcopenia undergoing cardiac surgery at a tertiary medical centre. Presurgical sarcopenia was defined as low muscle mass plus either low strength or poor physical performance (i.e. reduced gait speed). Secondary outcomes (length of hospital stay and 1-year mortality) were compared between sarcopenia and non-sarcopenia groups.
Sarcopenia presented in 27.7% ( n=67) of 242 participants. Participants with sarcopenia were significantly older, predominantly women, and had lower body mass index and higher cardiac surgery risk (measured by the EuroSCORE II) than those without sarcopenia. For both groups, physical activity levels, walking distance and grip strength steadily improved over the year following cardiac surgery. Independent of EuroSCORE II, changes in physical activity levels, walking distance and grip strength did not differ significantly between the sarcopenia and non-sarcopenia groups 1, 3, 6 and 12 months after surgery. Nevertheless, the sarcopenia group had a significantly longer length of hospital stay than the non-sarcopenia group (19.4 vs. 15.3 days; β=2.9, P=0.02) but 1-year mortality (3.4 vs. 3.9% for non-sarcopenia group) was comparable.
Despite a longer length of hospital stay for the sarcopenia group, sarcopenia was not a restriction for cardiac surgery given their comparable functional improvement and mortality 1 year following surgery.
肌少症与术后不良结局相关。
评估肌少症对心脏手术后第一年功能变化的影响。
在这项前瞻性队列研究中，比较了在一家三级医疗中心接受心脏手术的成人患者中，有无肌少症患者在术前基础期至术后 1、3、6 和 12 个月的功能变化（代谢当量小时/周的体力活动水平、米的 6 分钟步行距离和公斤的握力）。术前肌少症定义为肌肉量低加上力量弱或身体机能差（即步行速度减慢）。比较了肌少症组和非肌少症组的次要结局（住院时间和 1 年死亡率）。
242 名参与者中，27.7%（n=67）存在肌少症。与非肌少症组相比，肌少症组患者年龄更大，主要为女性，体重指数更低，心脏手术风险更高（用欧洲心脏手术风险评分 II 测量）。对于两组患者，体力活动水平、步行距离和握力在心脏手术后的一年中都稳步提高。独立于欧洲心脏手术风险评分 II，肌少症组和非肌少症组在术后 1、3、6 和 12 个月时，体力活动水平、步行距离和握力的变化没有显著差异。然而，肌少症组的住院时间明显长于非肌少症组（19.4 天 vs. 15.3 天；β=2.9，P=0.02），但 1 年死亡率（非肌少症组为 3.4% vs. 3.9%）相似。
尽管肌少症组的住院时间较长，但考虑到他们在手术后 1 年的功能改善和死亡率相当，肌少症并不是心脏手术的限制因素。
