外科术后入ICU患者的虚弱程度与临床结局之间的关系：一项系统综述和Meta分析

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外科术后入ICU患者的虚弱程度与临床结局之间的关系：一项系统综述和Meta分析

贵州医科大学 麻醉与心脏电生理课题组

翻译：佟睿  编辑：马艳燕  审校：曹莹

罂 粟 摘       要

背景：术前虚弱可能是术后不良结果的有力预测指标。本研究调查了外科术后入ICU患者的虚弱程度和临床结果之间的关系。

方法：我们检索了PubMed、Embase和Ovid MEDLINE数据库中收录的应用虚弱程度的相关文献原文。文献报导了术后入ICU成年(≥18岁)外科患者的结局，并以死亡率为主要观察指标。提取患者死亡率、机械通气时间、ICU和住院时间以及出院目的地的数据。纳入研究的质量和偏倚风险采用渥太华纽卡斯尔量表进行评估。根据系统综述和Meta分析指南的首选项目来综合处理数据。

结果：共有13项观察性研究符合纳入标准。总共纳入58757名患者，其中22793名(39.4%)存在身体虚弱状况。虚弱与短期风险(风险比：2.66；95%可信区间[CI]：1.99-3.56)和长期死亡率(风险比：2.66；95%CI：1.32-5.37)相关。虚弱患者的ICU住院天数(均差[MD]=1.5天；95%CI：0.8-2.2)和住院天数(MD=3.9天；95%CI：1.4-6.5)较长。虚弱患者的机械通气时间更长(MD=22h；95%CI：1.7-42.3)，而虚弱患者出院后也更大概率转运到医疗机构继续治疗(RR=2.34；95%CI：1.36-4.01)。

罂   粟   摘   要  

  结论  

因择期手术或急诊手术而需要术后入ICU的虚弱患者的死亡风险增加，住院时间延长，非家庭出院的可能性增加。术前虚弱评估和风险分层在患者与临床医生的计划，以及重症监护资源的利用中是必不可少的。

  原始文献来源  

Rachel Chan, Ryo Ueno, Afsana Afroz, et al. Association between frailty and clinical outcomes in surgical patients admitted to intensive care units: a systematic review and meta-analysis. [J]Br J Anaesth, 128(2): 258-271(2022).

英文原文  

Association between frailty and clinical outcomes in surgical patients admitted to intensive care units: a systematic review and meta-analysis

Background: Preoperative frailty may be a strong predictor of adverse postoperative outcomes. We investigated the association between frailty and clinical outcomes in surgical patients admitted to the ICU.

Method: PubMed, Embase, and Ovid MEDLINE were searched for relevant articles. We included full-text original English articles that used any frailty measure, reporting results of surgical adult patients (≥18 yr old) admitted to ICUs with mortality as the main outcome. Data on mortality, duration of mechanical ventilation, ICU and hospital length of stay, and discharge destination were extracted. The quality of included studies and risk of bias were assessed using the Newcastle Ottawa Scale. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

Results: Thirteen observational studies met inclusion criteria. In total, 58 757 patients were included; 22 793 (39.4%) were frail. Frailty was associated with an increased risk of short-term (risk ratio [RR]=2.66; 95% confidence interval [CI]: 1.99-3.56) and long-term mortality (RR=2.66; 95% CI: 1.32-5.37). Frail patients had longer ICU length of stay (mean difference [MD]=1.5 days; 95% CI: 0.8-2.2) and hospital length of stay (MD=3.9 days; 95% CI: 1.4-6.5). Duration of mechanical ventilation was longer in frail patients (MD=22 h; 95% CI: 1.7-42.3) and they were more likely to be discharged to a healthcare facility (RR=2.34; 95% CI: 1.36-4.01).

Conclusion: Patients with frailty requiring postoperative ICU admission for elective and non-elective surgeries had increased risk of mortality, lengthier admissions, and increased likelihood of non-home discharge. Preoperative frailty assessments and risk stratification are essential in patient and clinician planning, and critical care resource utilisation.

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