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Circulation:虚弱和非虚弱老年人的营养不良和主动脉瓣置换术后的死亡率

2018-07-08 xiangting MedSci原创

术前营养状况与主动脉瓣置换术后老年人的死亡率相关。

接受主动脉瓣置换术的老年人有营养不良的风险。目前术前营养状况与中期死亡率之间的关联尚不清楚。

FRAILTY-AVR是一项前瞻性多中心国际性队列研究,于2012-2017在3个国家的14个中心进行。纳入接受经导管主动脉瓣置换术(TAVR)或外科主动脉瓣置换术(SAVR)的≥70岁患者。由经过训练的观察员在术前评估微型营养评估-简表(MNA-SF),满分14分,≤7分为营养不良, 8-11分为存在营养不良风险。同时评估短物理性能电池(SPPB)以测量身体虚弱,满分12分,得分≤5为重度虚弱,6-8为轻度虚弱。主要结局是1年全因死亡率,次要结局是30天复合死亡率或主要发病率。使用多因素回归模型调整潜在混杂因素。

共有1,158名患者(727名TAVR和431名SAVR),女性占45%,平均年龄81.3岁,平均体重指数为27.5 kg/m2,平均胸外科医师协会-预测死亡风险(STS-PROM)为5.1%。总体而言,8.7%的患者被分类为营养不良,32.8%的患者存在营养不良风险。MNA-SF评分与SPPB评分中度相关(Spearman R=0.31,P<0.001)。TAVR组有126名患者死亡(每100患者年19.1),SAVR组有30名患者死亡(每100患者年7.5)。与营养状况正常的患者相比,营养不良患者的1年死亡风险高出近3倍(28%vs 10%,P<0.001)。在调整虚弱、STS-PROM和手术类型后,术前营养状况是1年死亡率 (每1 MNA-SF分OR 1.08, 95% CI 1.01-1.16) 和30天复合安全性终点(每1 MNA-SF分OR 1.06, 95% CI 1.00-1.12) 的重要预测因子。

术前营养状况与主动脉瓣置换术后老年人的死亡率相关。未来需要临床试验来确定术前和术后的营养干预是否可以改善这些易感患者的临床预后。

原始出处:

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    2019-06-02 1461fc2cm69暂无昵称

    怎么没有虚弱和血液透析的?

    0

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    2018-08-12 yxch48
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    2018-07-09 白袍甘道夫

    谢谢分享

    0

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