心臟術後病人衰弱盛行率及其身體活動功能之相關性研究

A Correlation Study of Frailty and Functional Trajectory in Patient Undergoing Cardiac Surgery

陳思穎(Ssu-Ying Chen)

指導教授 ： 陳佳慧

國立臺灣大學/醫學院/護理學研究所/碩士(2014年)

https://doi.org/10.6342/NTU.2014.00438

摘要

衰弱及心臟血管疾病，為健康老化重要的威脅之一。衰弱指的是身體儲存能量或抗壓力下降，無法有效因應外在壓力源，而對健康產生不良結果。越來越多文獻指出，衰弱與心臟血管疾病有著共同的病理機轉，主要以神經-內分泌失調、慢性炎症反應以及凝血路徑-促血栓狀態三個路徑呈現，衰弱在心臟血管疾病患者，盛行率可達25-50%，接受心臟手術的患者也高達42%，衰弱的發生常加速疾病惡化、術後失能以相關不良結果發生。
本研究為觀察性研究，以接受心臟手術病患為收案對象，在術前、術後一、三、六個月評估衰弱、握力、六分鐘行走距離以及身體組成之變化，以測量術後衰弱發生率及身體活動功能改變與恢復的情形。資料分析以變異數分析(ANOVA)檢定其多重比較測定，比較非衰弱組、衰弱傾向組與衰弱組在基本及工具性日常活動功能、六分鐘走路及握力的差異，檢定之顯著差異水準訂為p<0.05。
根據100位平均年齡為62.3±13.2歲的個案其資料分析結果顯示:(1)術後六個月內衰弱的盛行率分別為:術前19%、術後一個月35%、術後三個月9.9%、術後六個月8.8%。(2) 在衰弱轉變趨勢上，以「衰弱型態持平不變」為主，而「衰弱型態進步」，以術後三個月開始上升，在術後六個月時達高峰，在「衰弱型態退步」中，以術後一個月時為高峰，術後三個月時驟降。(3)術前有衰弱者在術前、術後第一個月時的基本日常活動功能皆顯著的偏低於前衰弱及非衰弱者(p<0.05)。(4)術前有衰弱者在術前、術後第一、六個月時的工具性活動功能皆顯著偏低於前衰弱及非衰弱者(p<0.05)。(5)術前有衰弱者在術前的平均握力顯著偏低於前衰弱及非衰弱者(p<0.05)，但於術後六個月內的恢復並無顯著差異。(6)術前有衰弱者在術前、術後三個月內的六分鐘走路距離皆顯著低於前衰弱及非衰弱者 (p<0.05)。

關鍵字

衰弱 ； 心臟血管疾病 ； 身體活動功能 ； 握力 ； 六分鐘行走距離 ； 身體組成

並列摘要

Frailty is an overarching geriatric syndrome characterized by decreased reserves against stressors and may lead to vulnerability. Clinically, frailty and cardiovascular disease (CVD) often exist concurrently. The prevalence of frailty is relatively high in patients with CVD (25-50%), and undergoing cardiac surgery patients (up to 42%). Furthermore, frailty may compromise functional recovery after cardiac surgery.
In this prospective study, 100 participants undergoing cardiac surgery were enrolled and assessed at 4 time points (before surgery, 1 month, 3-month, and 6-months after surgery). Fried’s frailty phenotype, grip strength, 6-minute walking distance, lean body mass, barthel index, and Lowton IADL were assessed.
The mean age was 62.3 subjects in the study, the results were below:(1) The prevalence of frailty was 19%、35%、9.9%、8.8% ,from before surgery to 6 months after operation.(2) With the view to the trajectory of frailty, most patients belonged the unchanged frailty group .In improved frailty group, the improvement started since three months post operation and reached the peak at six months post operation. However, it had the peak at one month post operation and dropped rapidly at three months post operation in the retrograde frailty group.(3) Frailty group had significantly poorer basic daily activities than non-frailty and pre-frailty groups before and one month after operation (p<0.05) (4) Frailty group had significantly poorer instrumental activity than non-frailty and pre-frailty groups before, one and six months after operation (p<0.05). (5) There was significant different (p<0.05) between the phenotype of frailty before operation and grip strength. However, it didn’t reach statistically significant between frailty and the recovery within six months after operation.(6) Frailty group had significantly shorter 6-minute walking distance than non-frailty and pre-frailty groups before and three months after operation (p<0.05).

並列關鍵字

frailty ； cardiovascular disease ； physical activity ； grip strength ； 6-minute walking distance ； body compositions

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