衰弱导向的老年神经介入术后肺炎风险管理的研究进展

doi:10.11958/20253188

天津医药 ›› 2026, Vol. 54 ›› Issue (6): 663-667.doi: 10.11958/20253188

衰弱导向的老年神经介入术后肺炎风险管理的研究进展

尚葛础¹(), 王冠²^,^△()

¹ 天津中医药大学研究生院（邮编301617）
² 天津中医药大学第二附属医院神经外科

收稿日期:2025-10-20 修回日期:2025-12-22 出版日期:2026-06-15 发布日期:2026-06-15
通讯作者: ^△E-mail：neurocrown@163.com
作者简介:尚葛础（1998），女，博士在读，主要从事神经外科疾病的中西医结合治疗方面研究。E-mail：1378834511@qq.com
基金资助:
国家重点研发计划中医药现代化专项(2022YFC3501100);天津市卫生健康委员会中医中西医结合科研课题(2023026)

Research progress on the risk management of frailty-oriented pneumonia after neurointervention in the elderly

SHANG Gechu¹(), WANG Guan²^,^△()

¹ Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
² Department of Neurosurgery, the Second Affiliated Hospital of Tianjin University of TCM

Received:2025-10-20 Revised:2025-12-22 Published:2026-06-15 Online:2026-06-15
Contact: ^△E-mail：neurocrown@163.com

尚葛础, 王冠. 衰弱导向的老年神经介入术后肺炎风险管理的研究进展[J]. 天津医药, 2026, 54(6): 663-667.

SHANG Gechu, WANG Guan. Research progress on the risk management of frailty-oriented pneumonia after neurointervention in the elderly[J]. Tianjin Medical Journal, 2026, 54(6): 663-667.

摘要/Abstract

摘要：

老年患者接受神经介入治疗后肺炎风险管理已成为临床关注的焦点。衰弱作为一种多系统生理储备耗竭的临床综合征，是术后不良事件的独立预测因子。该文系统综述衰弱在老年神经介入术后肺炎风险管理中的关键作用与临床应对策略，解析衰弱的多维概念内涵，评述不同衰弱评估量表在神经介入场景下的应用特征与选择逻辑，在此基础上构建以衰弱评估为导向的多学科协作护理路径和风险防控体系。通过系统整合衰弱管理理念，为提升老年神经介入患者围手术期安全提供理论依据和实践框架。

关键词: 中风, 肺炎, 老年人, 衰弱, 神经介入, 风险管理

Abstract:

The management of pneumonia risk in elderly patients after neurointerventional treatment has become the focus of clinical attention. Frailty, as a clinical syndrome characterized by the exhaustion of multi-system physiological reserves, is an independent predictor of adverse events after surgery. This article systematically reviews the key role of frailty and the clinical response strategies in the management of pneumonia risk after neurointerventional surgery in the elderly, analyzes the multi-dimensional concept of frailty, and reviews the application characteristics and selection logic of different frailty assessment scales in the neurointerventional setting. On this basis, a multidisciplinary collaborative care pathway, risk prevention and control system oriented by frailty assessment are constructed. Through the systematic integration of frailty management concepts, it provides theoretical basis and practical framework for improving the perioperative safety of elderly patients undergoing neurointerventional treatment.

Key words: stroke, pneumonia, aged, frailty, neurointerventional procedures, risk management

中图分类号:

R197.323，R743

图/表 1

参考文献 46

[1]	JIANG X, WANG J, HU Y, et al. Is endovascular treatment still good for acute ischemic stroke in the elderly? A meta-analysis of observational studies in the last decade[J]. Front Neurosci, 2023, 17:1308216. doi:10.3389/fnins.2023.1308216.
[2]	PREMAT K, DECHARTRES A, BAPTISTE A, et al. Comparison of rescue intracranial stenting versus best medical treatment alone in acute refractory large vessel occlusion:study protocol for the PISTAR multicenter randomized trial[J]. J Neurointerv Surg, 2025, 17(4):360-367. doi:10.1136/jnis-2024-021502.
[3]	WEBBER M, CASEY B, TUCKER L, et al. The conceptualisation and measurement of social frailty in older people:an umbrella review[J]. J Frailty Aging, 2025, 14(5):100078. doi:10.1016/j.tjfa.2025.100078.
[4]	GUO Z, HOU J, YU S, et al. Eosinophils,stroke-associated pneumonia,and outcome after mechanical thrombectomy for acute ischemic stroke[J]. Front Aging Neurosci, 2022, 14:830858. doi:10.3389/fnagi.2022.830858.
[5]	BAHAR A R, BAHAR Y, KIDESS G, et al. Association of frailty with outcomes in patients with large vessel occlusion stroke undergoing mechanical thrombectomy[J]. Neuroradiology, 2025, 67(4):845-854. doi:10.1007/s00234-025-03562-9.
[6]	BUSHNELL C, KERNAN W N, SHARRIEF A Z, et al. 2024 Guideline for the primary prevention of stroke:a guideline from the American Heart Association/American Stroke Association[J]. Stroke, 2024, 55(12):e344-e424. doi:10.1161/STR.0000000000000475.
[7]	GANESH K M, KRISHNA B. Utility of clinical frailty scale in intensive care unit[J]. Indian J Crit Care Med, 2025, 29(4):289-290. doi:10.5005/jp-journals-10071-24959.
[8]	GONG S, QIAN D, RIAZI S, et al. Association between the FRAIL scale and postoperative complications in older surgical patients:a systematic review and meta-analysis[J]. Anesth Analg, 2023, 136(2):251-261. doi:10.1213/ANE.0000000000006272.
[9]	WINDERMERE S A, MELNICK K, YAN S C, et al. Predictive power of the Fried phenotype in assessing postoperative outcomes in patients undergoing craniotomy for tumor resection[J]. Neurosurgery, 2025, 96(2):463-470. doi:10.1227/neu.0000000000003231.
[10]	ROLLER-WIRNSBERGER R, HERZOG C, LINDNER-RABL S, et al. Teaching comprehensive geriatric assessment(CGA) in medical education:a scoping review[J]. Eur Geriatr Med, 2025, 16(2):425-433. doi:10.1007/s41999-025-01157-4.
[11]	HAYES C, YIGEZU A, DILLON S, et al. Home-based comprehensive geriatric assessment for community-dwelling,at-risk,frail older adults:a systematic review and meta-analysis[J]. J Am Geriatr Soc, 2025, 73(6):1929-1939. doi:10.1111/jgs.19402.
[12]	LI Z, PANG M, ZHANG J, et al. Effect of ventilation modalities on the early prognosis of patients with poststroke sleep apnea[J]. Ann Clin Transl Neurol, 2024, 11(2):355-367. doi:10.1002/acn3.51956.
[13]	ST HILAIRE C, BURTON J, LUNKKADI K, et al. Frailty scores impact the outcomes of urgent carotid interventions in acute stroke patients:a comprehensive analysis of risk and prognosis[J]. J Vasc Surg, 2024, 80(6):1727-1735.e1. doi:10.1016/j.jvs.2024.07.096.
[14]	LUO O J, LEI W, ZHU G, et al. Multidimensional single-cell analysis of human peripheral blood reveals characteristic features of the immune system landscape in aging and frailty[J]. Nat Aging, 2022, 2(4):348-364. doi:10.1038/s43587-022-00198-9.
[15]	MEREUTA O M, ABBASI M, FITZGERALD S, et al. Histological evaluation of acute ischemic stroke thrombi may indicate the occurrence of vessel wall injury during mechanical thrombectomy[J]. J Neurointerv Surg, 2022, 14(4):356-361. doi:10.1136/neurintsurg-2021-017310.
[16]	SONG Z, LI W, HAN Y, et al. Investigating the shared genetic architecture between frailty and insomnia[J]. Front Aging Neurosci, 2024, 16:1358996. doi:10.3389/fnagi.2024.1358996.
[17]	BORIESOSDICK J, SUROV A, MICHAEL A, et al. Sarcopenia is a predictor of patient death in acute ischemic stroke[J]. J Stroke Cerebrovasc Dis, 2023, 32(12):107421. doi:10.1016/j.jstrokecerebrovasdis.2023.107421.
[18]	SHIRVANI O, FISCHBEIN P, BENDELLA Z, et al. Aetiology of acute respiratory insufficiency in patients with ischaemic stroke studied by chest CT scan[J]. Eur J Neurol, 2025, 32(3):e70125. doi:10.1111/ene.70125.
[19]	PINHO J, MEYER T, SCHUMANN-WERNER B, et al. Swallowing muscle mass contributes to post-stroke dysphagia in ischemic stroke patients undergoing mechanical thrombectomy[J]. J Cachexia Sarcopenia Muscle, 2024, 15(4):1539-1548. doi:10.1002/jcsm.13512.
[20]	HUANG M, WANG W, LI W L, et al. Construction and evaluation of a nomogram model for predicting the risk of hospital-acquired pneumonia in elderly patients with acute ischemic stroke[J]. BMC Geriatr, 2025, 25(1):340. doi:10.1186/s12877-025-05936-3.
[21]	SANTOS A C F F, COELHO L L S, CALDAS G C, et al. General anesthesia versus conscious sedation in mechanical thrombectomy for patients with acute ischemic stroke:systematic review and meta-analysis[J]. Arq Neuropsiquiatr, 2024, 82(4):1-7. doi:10.1055/s-0044-1785693.
[22]	SHAO Y R, KE X, LUO L H, et al. Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery[J]. World J Gastrointest Surg, 2023, 15(9):1910-1918. doi:10.4240/wjgs.v15.i9.1910.
[23]	MANCIN S, SGUANCI M, ANDREOLI D, et al. Nutritional assessment in acute stroke patients:A systematic review of guidelines and systematic reviews[J]. Int J Nurs Stud, 2024, 158:104859. doi:10.1016/j.ijnurstu.2024.104859.
[24]	WEIMANN A, BEZMAREVIC M, BRAGA M, et al. ESPEN guideline on clinical nutrition in surgery - Update 2025[J]. Clin Nutr, 2025, 53:222-261. doi:10.1016/j.clnu.2025.08.029.
[25]	BARBAGALLO M, ZAHN M, ZIMMERMANN J, et al. Reperfusion failure after successful thrombectomy of large vessel occlusion stroke:clinical and imaging evidence[J]. Front Neurol, 2025, 16:1639880. doi:10.3389/fneur.2025.1639880.
[26]	ARDELLIER F D, BALOGLU S, SOKOLSKA M, et al. Cerebral perfusion using ASL in patients with COVID-19 and neurological manifestations: A retrospective multicenter observational study[J]. J Neuroradiol, 2023, 50(5):470-481. doi:10.1016/j.neurad.2023.01.005.
[27]	STRBIAN D, TSIVGOULIS G, OSPEL J, et al. European Stroke Organisation(ESO)and European Society for Minimally Invasive Neurological Therapy (ESMINT) guideline on acute management of basilar artery occlusion[J]. J Neurointerv Surg, 2024, 16(9):e7. doi:10.1136/jnis-2024-022053.
[28]	OH T K, SONG I A. The impact of opioid prescription on the occurrence and outcome of pneumonia:a nationwide cohort study in South Korea[J]. Respir Care, 2024, 69(11):1424-1431. doi:10.4187/respcare.11870.
[29]	CHEN Q, QIN B, ZHANG M, et al. The safety and efficacy of remimazolam compared to dexmedetomidine for awake tracheal intubation by flexible bronchoscopy:a randomized,double-blind,controlled trial[J]. Drug Des Devel Ther, 2024, 18:967-978. doi:10.2147/DDDT.S446222.
[30]	NA TAKUATHUNG M, SAKULUDOMKAN W, KHATSRI R, et al. Adverse effects of angiotensin-converting enzyme inhibitors in humans:a systematic review and meta-analysis of 378 randomized controlled trials[J]. Int J Environ Res Public Health, 2022, 19(14):8373. doi:10.3390/ijerph19148373.
[31]	LIN Y Y, YU T Y, QUAN H, et al. Association between PSD95 gene 3'UTR single nucleotide polymorphism and risk of acute ischemic stroke in Chinese Han population[J]. J Mol Neurosci, 2020, 70(9):1389-1402. doi:10.1007/s12031-020-01559-y.
[32]	ZHANG H, MO X, WANG A, et al. Association of DNA methylation in blood pressure-related genes with ischemic stroke risk and prognosis[J]. Front Cardiovasc Med, 2022, 9:796245. doi:10.3389/fcvm.2022.796245.
[33]	SALMAN A T, SHAKER O, ELSHAER S S, et al. The expression profiling of serum miR-92a,miR-134 and miR-375 in acute ischemic stroke[J]. Future Sci OA, 2022, 8(10):FSO829. doi:10.2144/fsoa-2022-0074.
[34]	WANG Y, SHEN Y, LI Q, et al. Exploring the causal association between genetically determined circulating metabolome and hemorrhagic stroke[J]. Front Nutr, 2024, 11:1376889. doi:10.3389/fnut.2024.1376889.
[35]	RAMOS-VICENTE D, MONTEROSSO P, DE FàBREGUES O, et al. Single-cell transcriptomics for immune profiling of cerebrospinal fluid in neurological diseases[J]. Front Immunol, 2025, 16:1599303. doi:10.3389/fimmu.2025.1599303.
[36]	CHEN Q, WU M, TANG Q, et al. Age-related alterations in immune function and inflammation:focus on ischemic stroke[J]. Aging Dis, 2024, 15(3):1046-1074. doi:10.14336/AD.2023.0721-1.
[37]	ZHAO Z, ZHANG Y, SU J, et al. A comprehensive review for artificial intelligence on neuroimaging in rehabilitation of ischemic stroke[J]. Front Neurol, 2024, 15:1367854. doi:10.3389/fneur.2024.1367854.
[38]	ZHANG Z, DING Y, LIN K, et al. Development of an MRI based artificial intelligence model for the identification of underlying atrial fibrillation after ischemic stroke:a multicenter proof-of-concept analysis[J]. EClinicalMedicine, 2025, 81:103118. doi:10.1016/j.eclinm.2025.103118.
[39]	MARTIN-LOECHES I, TORRES A, NAGAVCI B, et al. ERS/ESICM/ESCMID/ALAT guidelines for the management of severe community-acquired pneumonia[J]. Intensive Care Med, 2023, 49(6):615-632. doi:10.1007/s00134-023-07033-8.
[40]	CINOTTI R, MIJANGOS J C, PELOSI P, et al. Extubation in neurocritical care patients:the ENIO international prospective study[J]. Intensive Care Med, 2022, 48(11):1539-1550. doi:10.1007/s00134-022-06825-8.
[41]	KLEINDORFER D O, TOWFIGHI A, CHATURVEDI S, et al. 2021 Guideline for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline from the American Heart Association/American Stroke Association[J]. Stroke, 2021, 52(7):e364-e467. doi:10.1161/STR.0000000000000375.
[42]	SHU L, AZIZ Y N, DE HAVENON A, et al. Perioperative stroke:mechanisms,risk stratification,and management[J]. Stroke, 2025, 56(9):2798-2809. doi:10.1161/STROKEAHA.125.051673.
[43]	LIU J, HE H, SU H, et al. The predictive value of the ARC-HBR criteria for in-hospital bleeding risk following percutaneous coronary intervention in patients with acute coronary syndrome[J]. Int J Cardiol Heart Vasc, 2024, 55:101527. doi:10.1016/j.ijcha.2024.101527.
[44]	ZHOU Y, SU X, LIU P, et al. Clinical characteristics and outcomes of hospitalized patients with intracranial hemorrhage after percutaneous coronary intervention[J]. Front Cardiovasc Med, 2025, 12:1424598. doi:10.3389/fcvm.2025.1424598.
[45]	ZHOU Z, XIE H, FAN F, et al. Comparison of in-hospital net clinical outcomes of ticagrelor and clopidogrel in acute coronary syndrome patients stratified by CRUSADE score:findings from the CCC-ACS registry[J]. Platelets, 2025, 36(1):2570743. doi:10.1080/09537104.2025.2570743.
[46]	PARKER K J, MCDONAGH J, FERGUSON C, et al. Clinical outcomes of nurse-coordinated interventions for frail older adults discharged from hospital:a systematic review and meta-analysis[J]. J Clin Nurs, 2024, 33(11):4184-4206. doi:10.1111/jocn.17345.

评估工具	核心评估维度	耗时	主要优点	主要局限性	适用场景
CFS^[7]	共病、功能依赖	1~2 min	极快，操作简便，无需特殊设备	相对主观，依赖评估者经验	急诊、分诊、住院患者快速风险筛查
FRAIL量表^[8]	疲劳、阻力、活动能力、疾病数、体重	1~3 min	简单快捷，患者可自评，预测死亡/跌倒风险佳	依赖患者主观陈述，在认知受损或沟通不畅者中准确性下降	门诊、社区及大型流行病学研究
Fried表型^[9]	握力、步速、体力活动、疲惫感、体重	10~15 min	客观量化，标准化程度高	非快速筛查工具，需设备支持，耗时较长	科学研究、流行病学调查
CGA^[10-11]	疾病、功能、认知、心理、社会、营养	>30 min	最全面，直接指导个体化治疗	耗时，需多学科团队	制定复杂患者管理计划

评估工具	核心评估维度	耗时	主要优点	主要局限性	适用场景
CFS^[7]	共病、功能依赖	1~2 min	极快，操作简便，无需特殊设备	相对主观，依赖评估者经验	急诊、分诊、住院患者快速风险筛查
FRAIL量表^[8]	疲劳、阻力、活动能力、疾病数、体重	1~3 min	简单快捷，患者可自评，预测死亡/跌倒风险佳	依赖患者主观陈述，在认知受损或沟通不畅者中准确性下降	门诊、社区及大型流行病学研究
Fried表型^[9]	握力、步速、体力活动、疲惫感、体重	10~15 min	客观量化，标准化程度高	非快速筛查工具，需设备支持，耗时较长	科学研究、流行病学调查
CGA^[10-11]	疾病、功能、认知、心理、社会、营养	>30 min	最全面，直接指导个体化治疗	耗时，需多学科团队	制定复杂患者管理计划

衰弱导向的老年神经介入术后肺炎风险管理的研究进展

Research progress on the risk management of frailty-oriented pneumonia after neurointervention in the elderly

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