衰弱的临床诊断与干预研究进展

Fei Fei Cong, Yang Fan, Jie Liu, Hongxia Xu
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摘要

摘要:跌倒、残疾、认知障碍、自主神经活动下降、体重意外减轻和疲劳等一系列症状在老年人中很常见。这种“核心症状复合体”定义了虚弱。虚弱常与营养不良有关,但可与肌肉减少症区分开来。虚弱体现了患者整体功能的下降,这并不能完全用骨骼肌质量的损失或肌肉功能的下降来解释。当个体的生理储备减少并伴有内部动态平衡紊乱和生理衰弱时,就会出现虚弱。虚弱与不良临床结果相关,包括其他疾病和手术并发症的风险增加、意外伤害(跌倒和骨折)、残疾、生活质量差,甚至死亡。虚弱不仅在老年人中很常见,在患有癌症、心血管疾病、呼吸系统疾病和营养不良的患者中也很常见。在不同的报告中,虚弱的患病率在4.0%-59.1%之间,并且随着年龄的增长而增加。虚弱可以通过核心症状复合体(虚弱表型)的存在或基于虚弱指数来诊断。早期评估和治疗可显著改善患者的健康预后。与专门治疗任何潜在疾病相比,旨在维持个体体内平衡的治疗更有利于预防或解决虚弱。改善患者的营养状况,实施体育锻炼,发展个性化的多学科干预可能是预防虚弱患者不良临床结果的最佳途径。本文综述了虚弱的定义、诊断、流行病学、病因学和发病机制,以及可用于对抗虚弱的干预措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Research Progress in Clinical Diagnostics and Interventions for Frailty
Abstract: A cluster of symptoms, including falls, disability, cognitive impairment, decreased autonomic activity, unintentional weight loss and fatigue, are common in older people. This “core symptom complex” defines frailty. Frailty is often related to malnutrition, but is distinguished with the presence of sarcopenia. Frailty embodies a decline in a patient’s overall function, which is not entirely explained by a loss of skeletal muscle mass or decreases in muscle function. Frailty occurs when the individual’s physiological reserve decreases in conjunction with internal dynamic balance disorders and physiological debility. Frailty is associated with adverse clinical outcomes including an increased risk of complications of other conditions and surgery, unintentional injury (falls and fractures), disability, a poor quality of life, and even death. Frailty is common not only in the elderly, but also in patients with cancer, cardiovascular diseases, respiratory diseases, and malnutrition. The prevalence of frailty has been reported to be between 4.0%-59.1% in different reports, and increases with age. Frailty can be diagnosed by the presence of the core symptom complex (frailty phenotype) or based on the frailty index. Early assessment and treatment can significantly improve the health prognosis of patients. Treatments aimed at maintaining an individual's homeostasis can be more beneficial for preventing or resolving frailty than specifically treating any underlying disease(s). Improving the patient’s nutritional status, implementing physical exercise, and developing individualized multidisciplinary interventions may be the best ways to prevent adverse clinical outcomes in patients with frailty. This article reviews the definitions, diagnosis, epidemiology, etiology and pathogenesis of frailty, as well as the interventions that can be used to combat frailty.
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