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Article(id=1322936916655612354, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.11.024, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749484800000, receivedDateStr=2025-06-10, revisedDate=1772899200000, revisedDateStr=2026-03-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793342339910, onlineDateStr=2026-10-30, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793342339910, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793342339910, creator=13701087609, updateTime=1793342339910, updator=13701087609, issue=Issue{id=1322936785516503921, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='11', pageStart='1809', pageEnd='2000', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793342308644, creator='13701087609', updateTime=1793343121351, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940194344796237, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940194344796238, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1981, endPage=1985, ext={EN=ArticleExt(id=1322936918291390915, articleId=1322936916655612354, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on the predictive value of frailty for adverse outcomes in elderly stroke patients, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

This study reviewed the concept of frailty,assessment methods,and predictive value for adverse outcomes in stroke patients,to provide reference for rehabilitation management and therapeutic decision-making of stroke patients,and to provide reference for management and evaluation of frailty in stroke patients.

, authors=Lei LIU1, Chunyu HE2, Wenbo CHEN2, Yan XIE2, Yanping JIANG3, Haiyu ZHANG3, authorsList=Lei LIU, Chunyu HE, Wenbo CHEN, Yan XIE, Yanping JIANG, Haiyu ZHANG, authorCompany=null, correspAuthors=Chunyu HE, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322936918601769412, articleId=1322936916655612354, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=衰弱对老年脑卒中病人不良结局预测价值的研究进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

从衰弱的概念、评估方法以及对脑卒中病人不良结局的预测价值进行综述，为脑卒中病人康复管理及治疗决策提供借鉴，为脑卒中病人的衰弱管理及评估提供参考。

, authors=刘蕾1, 何春渝2, *, *, 陈文博2, 谢艳2, 蒋艳萍3, 张海宇3, authorsList=刘蕾, 何春渝, 陈文博, 谢艳, 蒋艳萍, 张海宇, authorCompany=null, correspAuthors=何春渝, authorNote=

刘蕾，硕士研究生

, correspAuthorsNote=
何春渝，E-mail：
HE Chunyu, E-mail:
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刘蕾，硕士研究生

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刘蕾，硕士研究生

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衰弱对老年脑卒中病人不良结局预测价值的研究进展
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刘蕾 1 , 何春渝 2, *, * , 陈文博 2 , 谢艳 2 , 蒋艳萍 3 , 张海宇 3
护理研究 | 科研综述 2026,40(11): 1981-1985
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护理研究 |科研综述 2026 , 40 (11) : 1981 -1985
衰弱对老年脑卒中病人不良结局预测价值的研究进展
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刘蕾1, 何春渝2, *, * , 陈文博2, 谢艳2, 蒋艳萍3, 张海宇3
作者信息
  • 1四川大学华西公共卫生学院/四川大学华西第四医院，四川 610041
  • 2成都医学院护理学院
  • 3成都医学院第二附属医院
通讯作者:
何春渝，E-mail：
HE Chunyu, E-mail:
作者简介:

刘蕾，硕士研究生

Research progress on the predictive value of frailty for adverse outcomes in elderly stroke patients
Lei LIU1, Chunyu HE2 , Wenbo CHEN2, Yan XIE2, Yanping JIANG3, Haiyu ZHANG3
Affiliations
  • 1West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan 610041 China
  • 2School of Nursing, Chengdu Medical College
  • 3The Second Affiliated Hospital of Chengdu Medical College
出版时间: 2026-06-10 doi: 10.12102/j.issn.1009-6493.2026.11.024
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摘要
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从衰弱的概念、评估方法以及对脑卒中病人不良结局的预测价值进行综述，为脑卒中病人康复管理及治疗决策提供借鉴，为脑卒中病人的衰弱管理及评估提供参考。

脑卒中  /  衰弱  /  老年人  /  不良结局  /  综述

This study reviewed the concept of frailty,assessment methods,and predictive value for adverse outcomes in stroke patients,to provide reference for rehabilitation management and therapeutic decision-making of stroke patients,and to provide reference for management and evaluation of frailty in stroke patients.

stroke  /  frailty  /  the elderly  /  adverse outcomes  /  review
刘蕾, 何春渝, 陈文博, 谢艳, 蒋艳萍, 张海宇. 衰弱对老年脑卒中病人不良结局预测价值的研究进展. 护理研究, 2026 , 40 (11) : 1981 -1985 . DOI: 10.12102/j.issn.1009-6493.2026.11.024
Lei LIU, Chunyu HE, Wenbo CHEN, Yan XIE, Yanping JIANG, Haiyu ZHANG. Research progress on the predictive value of frailty for adverse outcomes in elderly stroke patients[J]. Chinese Nursing Research, 2026 , 40 (11) : 1981 -1985 . DOI: 10.12102/j.issn.1009-6493.2026.11.024
正文
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脑卒中作为全球范围内主要致死和致残的疾病之一，给病人及其家庭带来了巨大的生理、心理和经济负担[1]。随着现代医学技术的发展，脑卒中急性期治疗取得了显著进步，但病人的长期康复和生活质量依然面临诸多挑战。因此，关注脑卒中病人的康复护理，特别是对长期结局的预测，具有重要临床意义和社会意义。衰弱是一种临床综合征，指随着年龄增长，生理功能、认知能力和身体健康状况逐渐减退的过程，包括肌肉质量和力量下降、认知功能减退、免疫系统功能和内分泌系统功能减退等，导致病人易受外界压力影响，容易出现不良健康结局[2]。衰弱评估需要综合评价病人身体功能、心理状况和社会支持等多方面的指标[3]，其在预测病人的康复潜力和长期结局方面的重要性逐渐受到关注，同时也可以为护理人员制定个性化的康复计划提供关键依据，从而提高病人的生活质量。在此背景下，国际衰弱和肌肉减少症协会（ICFSR）推荐将衰弱筛查和评估纳入老年脑卒中病人的康复和预后管理中[4]。因此，本研究就衰弱在老年脑卒中病人不良结局中的预测价值进行综述，以期为护理人员提供构建更有针对性的康复护理策略的实证依据，进而改善脑卒中病人的长期结局和生活质量。
1　衰弱概述
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1.1　概念
衰弱是与年龄相关的生物学临床综合征，核心问题是老年人的生理储备能力下降和多系统平衡机制的紊乱[5]。这种状态使个体在经受应激事件之后难以恢复自身动态平衡，同时增加了个体对不良健康事件的易感性，导致病人抗应激能力减弱，易受外界压力的影响，从而容易出现不良健康结局，如跌倒、骨折、功能丧失、住院和死亡，不但严重降低老年人的健康预期寿命和生活质量，还会导致医疗和照护成本增加[6]。目前衰弱已成为老年医学、护理学等学科关注的热点议题之一，因为涉及老年人群在生理、心理和社会等多个维度的健康状况。其常见的症状包括持续疲乏、体重减轻、活动能力下降、生活质量降低等，这些症状可能会引发一系列的身体和心理问题，如感染、压力性损伤、抑郁和焦虑等，进一步影响病人的健康和生活质量。
1.2　评估方法
衰弱评估是识别和管理衰弱的关键环节，对于脑卒中病人而言，衰弱评估不仅能够帮助改善脑卒中病人的康复效果，还可以降低其再次发病的风险[7]。目前已开发了多种的衰弱评估工具，包括基于生理测量的评估工具、问卷调查工具、生物标志物等，每种工具都有其独特的应用场景和优势。基于生理测量的衰弱评估工具，如衰弱表型（Physical Frailty Phenotype，PFP）、FRAIL量表，主要通过测量病人的身体状况评估其衰弱程度，包括握力测量、步行速度测试等，这类工具的优点在于能够较为直观和客观地反映病人的身体状态，但操作过程可能较为复杂，需要一定的专业技能[8]。问卷调查类的工具包括Tilburg衰弱量表（Tilburg Frailty Indicator，TFI）、Program of Research to Integrate the Services for the Maintenance of Autonomy（PRISMA-7）、埃德蒙顿衰弱量表（Edmonton Frail Scale，EFS）等，这些衰弱评估工具可以获取脑卒中病人或其亲属对病人心理状态、日常生活能力以及社会参与等方面的主观评估，尽管这类工具可能受到主观因素的影响，但能够提供补充生理测量可能忽略的重要信息[9-10]。此外，老年综合评估（Comprehensive Geriatric Assessment，CGA）和衰弱指数（Frailty Index，FI）是更全面、多维度的衰弱评估方法。CGA是一种多学科的评估方法，用于识别老年人在生物、心理和社会方面的健康问题。在评估衰弱时，CGA包括对功能能力、认知状态、情感状况、社会支持、生活质量、营养状况和共患疾病的评估[11]。FI包括心理、生活、生理功能及既往史4个方面，共30~70个项目，评估难度较大，但可获得较为全面的信息[12]。另外，生物标志物的使用为衰弱评估提供了新的视角，研究发现，炎性生物标志物（如C反应蛋白、白介素-6）、内分泌生物标志物（如生长激素、甲状腺激素）、蛋白质生物标志物（如血红蛋白、肌动蛋白）与老年脑卒中病人的衰弱程度和康复预后存在相关关系[13]。在评估衰弱时，医护人员需根据病人具体情况选择合适的评估工具，以便充分了解病人的整体健康状况和需求。这将有助于制定针对性的干预策略，延缓衰弱进程，提高老年人的生活质量。
2　衰弱对老年脑卒中病人结局的预测价值
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2.1　死亡风险
研究表明，衰弱对脑卒中病人死亡风险的结局预测具有重要价值，但目前研究较多关注28 d、3个月和6个月的死亡率，较少关注远期死亡率。一项纳入14项研究、涉及27 210例脑卒中病人的系统评价发现，即使调整心血管危险因素后，衰弱状态仍与死亡风险独立相关[OR=3.71，95%CI（2.13，5.70），P<0.01][14]。同样，Evans等[15]使用临床衰弱量表（Clinical Frailty Scale，CFS）对433例75岁以上的缺血性脑卒中病人进行调查，发现衰弱程度的增加与28 d内死亡率独立相关，在调整心血管危险因素和脑卒中严重程度等混杂因素后，两者仍存在关联。Imaoka等[16]对153例自发性脑出血病人调查研究显示，与单独的Hemphill脑出血评分（Hemphill Intracerebral Hemorrhage Score）相比，Hemphill脑出血评分联合改良衰弱指数（Modified Frailty Index，mFI）对预测术后结局的判别能力显著提高，研究结果显示，衰弱是自发性脑出血病人术后不良结局有用且可靠的预测指标。Kilkenny等[17-19]均调查了衰弱对脑卒中后3个月死亡风险的预测价值，研究结果一致，均证实了衰弱是其死亡风险的独立预测因素。综上所述，衰弱可能是老年脑卒中病人短期死亡率的预测因素，但对长期预后的价值仍未明确，因此需要进一步地深入研究以验证其有效性。
2.2　复发/再入院
衰弱可以预测脑卒中病人复发及再入院风险。Hanlon等[20]使用了来自3个关于老龄化的国际人口调查（美国健康与退休调查、英国老龄化纵向研究和欧洲健康与退休调查）数据，并采用PFP、FI和CFS量表评估研究对象的衰弱状态，通过2年随访结果显示，在9 617例脑卒中幸存者中，衰弱与脑卒中病人复发和再入院风险增加相关。一项对澳大利亚15 468例脑卒中病人的回顾性研究表明，衰弱评估可以预测脑卒中病人的再入院风险[17]。该研究通过收集2009—2013年住院治疗脑卒中病人的数据，发现与非衰弱病人相比，处于衰弱状态的脑卒中病人住院时长延长的可能性约为3倍，同时，低、中、高衰弱风险的病人与非衰弱病人相比，90 d再入院的可能性分别为1.3、1.6、2.1倍。廖若彤[21]对脑出血病人的研究也证实了这一点，其通过对227例脑卒中病人的3次随访发现，衰弱是脑卒中后6个月内再入院的危险因素，衰弱程度越严重，病人复发的风险越高。总体来说，对脑卒中病人进行衰弱评估与筛查，可以降低其复发及再入院风险。未来应进一步探讨衰弱与其他预测因素的结合，以提高预测的准确性，为脑卒中病人的康复和治疗提供更好的指导。
2.3　功能状态
研究发现，超过80%的脑卒中病人会出现运动功能障碍，20%~30%常遗留其他不同程度的功能障碍，导致病人出现躯体功能降低和日常活动能力受损情况，同时增加了病人发生治疗相关并发症和不良结局的风险[22]。Miranda等[23]为了评估PRISMA-7对老年急性缺血性脑卒中病人残疾的预测性能，将其与FI和美国国立卫生研究院脑卒中量表（National Institute of Health Stroke Scale，NIHSS）进行比较，结果显示，PRISMA-7对脑卒中后90 d残疾的阳性预测值为89%[95%CI（77%，99%）]，提示基于PRISMA-7的衰弱诊断可能是脑卒中后残疾的预测指标，其预测性能与FI或NIHSS评分比较差异无统计学意义。Noguchi等[24]通过前瞻性队列研究发现，衰弱与脑卒中后预后不良之间呈正相关，结果表明，在脑卒中后期，衰弱评估可以用于预测病人的长期功能状态，该研究还发现，早期的衰弱评估可以在康复治疗中起到重要作用，有助于制定更好的治疗方案。综上所述，衰弱是脑卒中病人功能状态结局的有效预测因素，可以帮助医生更好地评估病人的风险，并早期识别需要更多康复治疗的脑卒中病人，制定更好的治疗方案和预防策略，从而有助于改善其功能状态和生活质量。
2.4　术后结局
研究显示，与非衰弱病人相比，脑卒中前衰弱病人在接受静脉溶栓治疗后获得显著改善的可能性较小，接受机械血栓切除术（mechanical thrombectomy，MT）治疗的老年脑卒中衰弱病人死亡率和不良结局发生率高于年轻病人[25]。Schnieder等[19]通过回顾性观察队列研究分析了2015—2019年入院接受血管内治疗的≥65岁病人，结果表明，衰弱病人在术后90 d的神经系统功能更差，即使是中度衰弱病人，也只有20%达到良好结果。因此，使用医院衰弱风险评分（Hospital Frailty Risk Score，HFRS）识别衰弱病人并进行分层风险管理可以有效地预测脑卒中病人的术后并发症、死亡风险和康复不良。Pinho等[26]研究发现，衰弱是接受机械血栓切除术治疗的急性缺血性脑卒中病人预后的独立预测因子，3个月预后良好的病人表现出较低的HFRS发病率，高衰弱风险与3个月预后良好的可能性降低独立相关。Joyce等[27]研究结果显示，衰弱在恶性肿瘤病人中很常见，脑卒中前衰弱的存在与术后的高死亡率和残疾有关。因此，对脑卒中病人常规进行衰弱评估，有助于病人和医生做出机械血栓切除术的决策。Tiainen等[18]调查≥80岁缺血性脑卒中恶性肿瘤病人的结局，将近60%的病人预后很差，衰弱显著增加了恶性肿瘤治疗后不良结局和死亡的可能性。除了接受机械血栓切除术治疗的病人，Imaoka等[16]探讨了mFI与自发性脑出血病人术后结局之间的关系，结果显示，较高的mFI与病人不良结局和死亡率相关。Evans等[15]调查了衰弱对缺血性脑卒中病人溶栓后结局的影响，研究结果显示，衰弱与溶栓后NIHSS改善减弱独立相关，但还需进一步的研究来阐明潜在的机制以及衰弱如何影响神经功能恢复，可能有益于预后、临床决策和服务质量。总之，衰弱评估作为一种新的评估方法，已经逐渐被应用于脑卒中病人的术后康复中，并取得了一定的预测价值，未来的研究需要进一步探讨衰弱评估的标准化和精准化。此外，还需要开展更多的前瞻性研究，探讨不同类型脑卒中病人衰弱的发生率及预测价值，以指导临床实践。
2.5　认知功能
认知障碍是脑卒中后主要的并发症之一，会对病人的注意力和执行力造成严重损伤，并降低其长期生活质量。一项流行病学调查显示，脑卒中后认知障碍的总体患病率为30%~50%，重度和轻度脑卒中病人的认知障碍发病率分别为34.0%和8.2%[28]。研究表明，在一般人群中，衰弱与认知障碍之间存在关联，并且衰弱与血管性痴呆之间存在关联[29]。在挪威脑卒中后认知障碍（Nor-COAST）研究中，Munthe-Kaas等[30]比较了脑卒中前FI与脑卒中前改良Rankin评分（modified Rankin Scale，mRS）对脑卒中后认知障碍的预测价值，结果显示，FI的预测值高于脑卒中前mRS，在调整性别、教育、抗生素治疗、急性脑卒中进展或入院时的NIHSS评分后，FI的预测价值几乎保持不变，研究也表明，对于脑卒中后认知障碍，衰弱是比脑卒中前mRS更强的预测因子，衰弱测量可能是脑卒中后认知功能预测模型的一部分。Taylor-Rowan等[31]研究了脑卒中前衰弱与急性发作后认知功能之间的关联，结果显示，脑卒中前衰弱与较低的脑卒中后认知程度相关。以上研究结果提示，衰弱是脑卒中后认知功能下降的预测因子，在评估认知功能时，临床医护人员应评估病人的衰弱情况。未来的研究应进一步确定衰弱对脑卒中后认知功能的长期影响。
2.6　生活质量
随着医疗水平的不断提高，脑卒中病人的生存率明显提升，但其高致残率往往会导致病人身体受损、经济压力增大，也成为影响脑卒中病人生活质量的重要因素。因此，也需要重视脑卒中后的长期生活质量。Kilkenny等[17]在90~180 d的随访期间，使用欧洲五维健康问卷三级版本（EuroQol Five Dimensions Questionnaire with three levels，EQ-5D-3L）评估病人脑卒中后的健康相关生活质量，结果显示，衰弱病人脑卒中后生活质量较差，可能与脑卒中后导致的一系列并发症有关。Wæhler等[32]调查了轻度脑卒中病人的健康相关生活质量，结果表明，在3个月和18个月时，衰弱病人在脑卒中后健康相关生活质量受损并继续恶化，而非衰弱脑卒中病人具有较好的生活质量。因此，衰弱在脑卒中中得到更大的关注，以提供更好的个性化治疗、康复和护理计划，并且应考虑对老年急性脑卒中病人进行常规衰弱筛查。需要注意的是，目前衰弱评估在脑卒中术后结局预测中的应用还处于起步阶段，有待进一步深入研究。此外，不同研究所采用的衰弱评估工具和评估时间可能会影响预测结果的准确性。因此，需要更多的研究比较不同评估工具的预测价值，并制定更准确和可靠的预测模型。
3　小结与展望
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通过早期评估脑卒中病人衰弱情况，可以尽早预测其不良结局发生的风险，并制定更具针对性的治疗和护理方案，改善病人的结局和提高病人的生活质量。衰弱在脑卒中病人死亡风险、复发/再入院、功能状态、术后结局、认知障碍、生活质量等方面具有一定的预测价值，但对于认知障碍和生活质量部分的研究较少，还需要在以后的研究中进一步验证。此外，研究者也在不断探索更为精确和便捷的衰弱评估工具，如通过构建预测模型更加精准地判断脑卒中病人衰弱情况，但目前尚未检索到其在临床实际情况中进行验证的研究，未来可进一步开发针对脑卒中病人特异性的衰弱评估工具，并尝试在不同康复阶段中应用，以期获得更好的预测效果。
尽管目前衰弱评估在脑卒中病人结局预测中取得了一定进展，但仍存在一些问题和挑战，如评估工具的准确性和可靠性、护理人员的技能和知识储备以及评估与实践的有效整合等。未来研究需进一步完善衰弱评估工具和方法，提高其准确性和实用性，并加强护理人员的培训和教育，推广衰弱评估在脑卒中病人中的应用，以及加强跨学科合作，实现衰弱评估在脑卒中康复护理中的最大化效益。同时，未来研究还需要深入探讨衰弱评估在脑卒中病人不同康复阶段的适用性以及其在特殊人群（如老年病人、多发病病人等）中的应用价值。此外，还可以探索新型技术（如人工智能、可穿戴设备等）在衰弱评估中的应用，有望提高评估效率和准确性，满足日益复杂的临床需求。通过对这些问题的深入研究，有望推动衰弱评估在脑卒中病人护理领域的不断创新和发展，为改善脑卒中病人的长期结局和生活质量作出贡献，同时为护理实践和研究提供有益的启示。

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doi: 10.12102/j.issn.1009-6493.2026.11.024
  • 接收时间：2025-06-10
  • 首发时间：2026-10-30
  • 出版时间：2026-06-10
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  • 收稿日期：2025-06-10
  • 修回日期：2026-03-08
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    1四川大学华西公共卫生学院/四川大学华西第四医院，四川 610041
    2成都医学院护理学院
    3成都医学院第二附属医院

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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