Impaired recovery of strength in older patients after major abdominal surgery.
Impaired recovery of strength in older patients after major abdominal surgery.
复制标题
腹部大手术后老年患者体力恢复受损。
DOI：
10.1097/00000658-199309000-00017
复制
发表时间：
1993
影响因子：
9
通讯作者：
Jian
中科院分区：
文献类型：
--
作者：
James M. Watters;S. M. Clancey;S. Moulton;Kathleen M. Briere;Jian
客观化
这项研究比较了年轻和老年患者在主要择期腹部手术后肌肉力量的变化，并将这些变化与身体成分和氮平衡联系起来。
摘要背景数据
肌肉蛋白质的分解、瘦肉组织的侵蚀和负氮平衡是外科疾病的典型代谢反应。随着年龄的增长，典型的肌肉质量会大幅下降，作者推测，在急性外科疾病期间，老年患者会变得更虚弱，维持肌肉功能和满足代谢需求的能力更差。
方法
研究对象是正在接受腹部大手术的活跃的社区居民，这些人年龄在70岁或以上或50岁或以下。术前用氧化氢稀释法测定全身水(TBW)。分别于术前、术后第2、4、6天测量最大自主握力、呼吸肌力和视觉模拟疼痛评分，术后7天收集尿液测定总氮、肌酐和皮质醇。
结果
青年组(年龄36+/-9岁[平均+/-9岁]；n=20)和老年组(77+/-5岁；n=20)在体重、性别分布、营养状况、手术操作和麻醉以及术后尿皮质醇水平方面相似。年龄组、术后时间和交互作用对每个力量变量均有显著影响(经方差分析均为P<；0.005)。年龄较大的患者术前强度较低(29%至41%)，平均24小时尿肌酐(27%)。术后第2天强度下降最为明显，两个年龄组的比例变化相似，但老年患者的绝对水平较低。在老年患者中，力量恢复的速度和完成率明显较低。与年轻患者相比，年龄较大的患者术后疼痛较少，接受的非肠外麻醉剂也少得多。术后各组尿氮无明显差异。力量的恢复与恶性肿瘤、术前力量、肌肉质量(尿肌酐)、瘦体重(TBW)、性别、恶性肿瘤、疼痛或麻醉用药无关。
结论
老年患者术前较年轻患者虚弱；术后力量下降至较低水平，术后力量恢复受损。老年患者的术前力量较弱在很大程度上是由于肌肉质量的减少，但并不完全是。他们术后恢复受损似乎与更严重的因素有关，如肌肉能量学或底物可获得性。
OBJECTIVE
This study compared changes in muscle strength after major elective abdominal surgery in young and old patients, and related these changes to body composition and nitrogen balance.
SUMMARY BACKGROUND DATA
The breakdown of muscle protein, erosion of lean tissue, and negative nitrogen balance are characteristic metabolic responses to surgical illness. With a substantial loss of muscle mass typical of advancing age, the authors postulated that older patients would be weaker during acute surgical illness and less able to maintain muscle function and meet metabolic demands.
METHODS
Active, community-dwelling individuals undergoing major abdominal procedures who were 70 years of age or older or 50 years of age or younger were studied. Total body water (TBW) was determined preoperatively by deuterium oxide dilution. Maximal voluntary handgrip, respiratory muscle strength, and visual analog pain scores were measured preoperatively and on postoperative days 2, 4, and 6. All urine was collected postoperatively for 7 days for determination of total nitrogen, creatinine, and cortisol.
RESULTS
The young (age, 36 +/- 9 years [mean +/- standard deviation]; n = 20) and old groups (age, 77 +/- 5 years; n = 20) were similar regarding weight, sex distribution, nutritional status, surgical procedures and anesthesia, and postoperative urine cortisol values. Age group, time after operation, and interaction effects were significant for each strength variable (all p < 0.005 by analysis of variance). Older patients had lower preoperative strength (29% to 41%) and mean 24-hour urine creatinine (27%). Postoperative strength was decreased most markedly on postoperative day 2, with similar proportional changes in the two age groups but lower absolute levels in the older patients. The rate of recovery of strength was substantially less rapid and complete in older patients. Older patients had less postoperative pain and received much less parenteral narcotic than younger patients. Postoperative urine nitrogen was similar in each group. Recovery of strength was not related to malignancy, preoperative strength, muscle mass (urine creatinine), lean body mass (TBW), sex, malignancy, pain, or narcotic administration.
CONCLUSIONS
Older patients are weaker preoperatively than younger patients; their strength falls to lower levels after surgery and their postoperative recovery of strength is impaired. The lesser preoperative strength of older patients is due in large part but not totally to diminished muscle mass. Their impaired postoperative recovery appears to be related to more acute factors, such as muscle energetics or substrate availability.