基于衰弱评估的预康复策略在老年胆石症患者外科治疗中的应用效果

目的 探讨基于衰弱评估的预康复策略在老年胆石症患者外科治疗中的应用效果。方法 采用目的抽样法，选取2022年5月—2022年9月湖南省人民医院门诊诊断为胆石症拟行择期手术的66例患者作为研究对象，随机分为对照组和实验组，每组33例。对照组接受常规的围手术期准备；实验组在对照组的基础上，实施预康复策略。比较两组干预前后的预康复相关指标和围手术期指标。结果 两组患者性别比例、年龄、文化程度、体质量指数、FRAIL量表、6分钟步行距离（6MWD）、医院焦虑抑郁量表（HADS）、营养风险筛查量表评分比较，差异均无统计学意义（P >0.05）。两组患者入院当天、术前24 h、术后5 d、术后30 d的FRAIL量表比较，结果 ①不同时间点的FRAIL量表评分比较，差异有统计学意义（P <0.05）；②两组患者FRAIL量表评分比较，差异有统计学意义（P <0.05），实验组较对照组低，效果较好；③两组患者FRAIL量表评分变化趋势比较，差异有统计学意义（P <0.05）。两组患者入院当天、术前24 h、术后5 d的白蛋白（Alb）、6MWD和HADS评分比较，结果 ①不同时间点的Alb、6MWD和HADS评分比较，差异均有统计学意义（P <0.05）；②两组患者Alb、6MWD和HADS评分比较，差异均有统计学意义（P <0.05）；实验组Alb、6MWD较对照组高，HADS评分较对照组低，实验组效果较好；③两组患者Alb、6MWD和HADS评分变化趋势比较，差异均有统计学意义（P <0.05）。实验组首次下床活动时间、住院时间短于对照组（P <0.05）。两组患者围手术期未发生并发症和病死情况。结论 在老年胆石症患者中应用基于衰弱评估的预康复策略，可有效改善患者衰弱、运动、营养、心理状态，提高患者的生活质量，促进患者快速康复。

Prehabilitation strategies based on frailty assessment in the surgical treatment of elderly patients with cholelithiasis

Objective To explore the efficacy of prehabilitation strategies based on frailty assessment in the surgical treatment of elderly patients with cholelithiasis.Methods With the purposive sampling method, 66 patients diagnosed with cholelithiasis planning to receive elective surgery in the outpatient department of Hunan Provincial People''s Hospital from May to September 2022, were selected and randomly divided into the control group and the experimental group, each with 33 cases. The control group received conventional perioperative treatment, and the experimental group was additionally treated with prehabilitation programs. Prehabilitation-related and perioperative indicators before and after the intervention were compared between the two groups.Results There was no difference between the two groups in sex composition, age, education degree, body mass index, the score of the FRAIL scale, the 6-minute walking distance (6MWD), or scores of Hospital Anxiety and Depression Scale (HADS) and Nutrition Risk Screening 2002 (P > 0.05). The scores of the FRAIL scale of the two groups on the day of admission, 24 hours before surgery, 5 days after surgery, and 30 days after surgery were compared, which demonstrated that there were differences in the scores of the FRAIL scale among the time points (P < 0.05) and between the two groups (P < 0.05), where those in the experimental group were lower compared with the control group, indicating higher efficacy in the experimental group. Besides, the change trends of the scores of the FRAIL scale were also different between the two groups (P < 0.05). The serum levels of albumin (Alb), 6MWD and the HADS scores in the two groups on the day of admission, 24 hours before surgery, and 5 days after surgery were compared, and the results revealed that they were different among the time points (P < 0.05) and between the groups (P < 0.05). Compared with the control group, the serum levels of Alb and 6MWD were higher, and the HADS scores were lower in the experimental group, which suggested better efficacy in the experimental group. There were differences in the change trends of the serum levels of Alb, 6MWD and HADS scores between the two groups (P < 0.05). The time to first postoperative off-bed activity and the length of hospitalization in the experimental group were shorter than those in the control group (P < 0.05). No complication or death occurred in either group during the perioperative period (P > 0.05).Conclusion For the elderly with cholelithiasis, prehabilitation strategies based on frailty assessment effectively improve the frailty, activity, nutrition, psychological status and the quality of life of patients, and promote early recovery among them.