虚弱状态和颅内脑膜瘤病人术后结局的相关性

doi:10.19854/j.cnki.1008-2425.2025.03.0009

摘要/Abstract

摘要： 目的改良虚弱指数(mFI-5) 是简易评估虚弱状态的新兴工具,虚弱状态是脑膜瘤手术重要危险因素。然而,mFI-5对脑膜瘤手术风险预测价值尚未在国内得到验证报道。因此,我们旨在探讨改良虚弱指数(mFI-5)对颅内脑膜瘤患者手术后不良结局的预测价值。方法我们连续性纳入西安交通大学第一附属医院神经外科2024年1月~2025年1月收治的脑膜瘤手术患者,从电子病例系统中提取患者信息,包括年龄、性别、吸烟状况、术前ASA评分、功能依赖性(包括完全和部分依赖)、手术时间、脑膜瘤位置、合并疾病情况:糖尿病 (DM)、慢性阻塞性肺病 (COPD)、高血压、充血性心力衰竭 (CHF)。计算mFI-5评分,其中 0 分为“非虚弱”,1 分定义为“虚弱前期”,2分或以上为“虚弱”。进行单变量和多变量 logistic 回归分析mFI-5评分对脑膜瘤术后入住ICU、出现主要并发症、住院时间延长和出院GOS评分等结局指标的预测价值。结果单变量和多变量logistic分析(根据性别、年龄、吸烟、肿瘤位置、ASA评分和手术时间进行调整)表明,mFI-5是颅内脑膜瘤患者术后不良结局的重要预测因子。根据比值比(OR)和效应大小,虚弱前期状态是脑膜瘤术后入住ICU(OR=2.574,95% CI 1.496~4.429,P＜0.001),出现主要并发症(OR=4.551,95% CI 1.775~11.672,P＜0.01),住院时间延长(OR=7.102,95% CI 3.235~15.592,P＜0.001)独立危险因素;虚弱状态是术后入住ICU(OR =5.284,95% CI 2.522~11.069,P＜0.001),出现主要并发症(OR=13.147,95% CI 4.808~35.950,P＜0.001),住院时间延长(OR=13.749,95% CI 5.432~34.796,P＜0.001),不良出院结局(OR=7.625,95% CI 2.247~25.874,P＜0.01)独立危险因素。结论改良虚弱指数(mFI-5)评估的虚弱状态是脑膜瘤患者手术后入住重症监护室、出现主要并发症、住院时间延长、不良出院结局的独立危险因素,证实了mFI-5对脑膜瘤患者的术后不良结局的预测价值,具有临床应用价值。

关键词: 脑膜瘤, 虚弱状态, 改良虚弱指数(mFI-5), 术后结局

Abstract: Objective Modified frailty index (mFI-5) is a new tool for simple assessment of frailty.Frailty is an important risk factor for meningioma surgery.However,the predictive value of mFI-5 for the surgical risk of meningioma has not been verified and reported in China.Therefore,we aimed to validate the predictive value of the modified frailty index (mFI-5) for poor outcomes in patients with meningioma after surgery.Methods We consecutively enrolled meningioma patients admitted to the Department of Neurosurgery,the First Affiliated Hospital of Xi 'an Jiaotong University from January 2024 to January 2025.Age,gender,smoking status,preoperative ASA score,functional dependence (including complete and partial dependence),operation time,location of meningioma,comorbidities:diabetes mellitus (DM),chronic obstructive pulmonary disease (COPD),hypertension,congestive heart failure (CHF).The mFI-5 score was calculated,where 0 was “non-frail”,1 was defined as “pre-frail”,and 2 or more was “frail”.Univariate and multivariate logistic regression analysis were used to analyze the predictive value of mFI-5 score for ICU admission,major complications,prolonged hospital stay and GOS score at discharge after meningioma surgery.Results Both univariate and multivariate logistic analyses (adjusted for sex,age,smoking,tumor location,ASA score,and operative time) indicated that mFI-5 was a significant predictor of postoperative poor outcomes in patients with intracranial meningiomas.Based on odds ratio (OR) and effect size,prefrailty was associated with ICU admission (OR=2.574,95% CI 1.496~4.429,P＜0.001) and major complications (OR=4.551,95% CI 1.775~11.672,P＜0.001) after meningioma surgery.P＜0.01),and prolonged hospital stay (OR=7.102,95%CI 3.235-15.592,P＜0.001).Frailty was associated with postoperative ICU admission (OR =5.284,95%CI 2.522~11.069,P＜0.001) and major complications (OR=13.147,95%CI 4.808~35.950,P＜0.001).Prolonged hospital stay (OR=13.749,95%CI 5.432~34.796,P＜0.001) and poor discharge outcome (OR=7.625,95%CI 2.247~25.874,P＜0.01) were independent risk factors.Conclusion Frailty assessed by the modified frailty index (mFI-5) is an independent risk factor for intensive care unit admission,major complications,prolonged hospital stay and poor discharge outcomes in patients with meningioma after surgery,which confirms the predictive value of mFI-5 for poor postoperative outcomes in patients with meningioma and has clinical application value.

Key words: Meningioma, Frailty status, Modified frailty index (mFI-5), Postoperative outcome

中图分类号:

R739.4

李辉, 刘永, 任宇涛, 孟强, 李焕发, 张华, 杜昌旺. 虚弱状态和颅内脑膜瘤病人术后结局的相关性[J]. 立体定向和功能性神经外科杂志, 2025, 38(3): 183-188.

Li Hui, Liu Yong, Ren Yutao, Meng Qiang, Li Huanfa, Zhang Hua, Du Changwang. Association of baseline frailty status with outcomes in patients undergoing intracranial meningioma surgery[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(3): 183-188.

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