目的 探讨老年脑卒中后2年跌倒的发生率、临床特点及危险因素.方法 对南宁市第八人民医院神经内科2013年6月至2014年12月住院的365例老年脑卒中患者根据是否出现跌倒分为跌倒组及非跌倒组,随访2年,分析跌倒的发生率及临床特点,对可能影响卒中后跌倒的危险因素进行多因素Logistic回归分析.结果 365例中跌倒146例(40.2％).首次跌倒时间:脑卒中后3个月72例(49.3％),4～6个月22例(15.1％),7～12个月20例(13.7％),13～18个月17例(11.6％),19～24个月15例(10.3％).首次跌倒于白天105例(71.9％),夜间41例(28.1％).跌倒次数:跌倒1次18例(12.3％),2～4次65例(44.5％),5～10次60例(41.1％),10次以上3例(2.1％),跌倒总次数709次.跌倒地点:家中跌倒102例(69.9％),户外跌倒44例(30.1％).跌倒环境:翻身时跌倒27例(18.5％),坐起时跌倒23例(15.8％),洗澡时跌倒4例(2.7％),站立时跌倒15例(10.3％),转身时跌倒9例(6.8％),走路时跌倒44例(30.1％),移动时跌倒12例(8.2％),上楼、跑步时跌倒12例.跌倒严重程度:无异常52例(35.6％),软组织损伤78例(53.2％),骨折16例(11.0％),害怕再次跌78例(53.2％).多因素Logistic回归分析示年龄(OR=2.41,95％CI:1.69～3.05)、既往跌倒史(OR=2.85,95％CI:1.46～3.81)、既往脑卒中史(OR=1.87,95％CI:1.12～2.79)、右侧肢体偏瘫(OR=2.37,95％CI:1.62～4.59)、左侧肢体偏瘫(OR=2.47,95％CI:1.46～4.78)、双侧肢体瘫痪(OR=2.55,95％CI:1.57～4.98)、视力损害(OR=2.35,95％CI:1.35～6.62)、共济失调(OR=2.53,95％CI:1.42～5.63)、单侧空间忽略(OR=3.34,95％CI:2.82～6.34)、精神药物(OR=1.76,95％CI:1.11～1.98)、移动需人扶助(OR=1.58,95％CI:1.82～2.91)、简易智力状况检查量表(MMSE)评分低(OR=3.42,95％CI:1.38～7.41)、日常生活能力评分(BI)评分低(OR=2.83,95％CI:0.97～4.68)、Berg平衡量表(BBS)评分<45分(OR=2.48,95％CI:1.27～4.18)、计时起走测试(TUG)>15 s(OR=3.56,95％CI:1.91～5.23)、不接受康复治疗(OR=3.42,95％C I:1.38～7.41)为跌倒的独立危险因素(均P<0.05).结论 跌倒在老年脑卒中后2年中常见,多发生在白天、家中以及完成日常生活动作时,可导致躯体及心理受损.脑卒中后高龄、有跌倒史及脑卒中史者为高危人群,加强防跌倒教育、改善家中及周围环境设施、康复训练、改善BI评分、肢体瘫痪、运动能力、视力损害、单侧空间忽略、平衡功能、认知功能、扶助患者移动以及减少精神药物的使用.%Objective To examine the incidence ,clinical characteristics ,and risk factors for falls within two years after stroke in elderly patients. Methods A total of 365 elderly stroke patients from the Department of Neurology at the 8th Nanning People's Hospital were recruited from June 1 , 2013 to December 31 ,2014. They were divided into a fall group and a non-fall group and were followed up for two years. The incidence and clinic characteristics of falls were analyzed. The risk factors for falls were analyzed by multiple Logistic regression analysis. Results Of the 365 stroke patients included in this study ,falls were observed in 146(40.2％ )patients. The interval between the stroke and the first fall :72(49.3％ )patients had the first fall within 3 months;22(15.1％ )occurred between 4 and 6 months;20 (13.7％ )between 7 and 12 months ;17 (11.6％ )between 13 and 18 months ;and 15 (10.3％ )between 19 and 24 months.A hundred and five(71.9％ )patients fell during daytime and 41 (28.1％ )patients during night.Eighteen(12.3％ )patients had one fall ;65(44.5％ )patients fell 2 to 4 times ;60(41.1％ )patients fell 5 to 10 times ;and 3(2.1％ )patients fell over 10 times.A total of 709 falls were observed.Places of falls :102(69.9％ )falls happened indoors and 44(30.1％ )falls occurred outdoors.Circumstances of falls :27 (18.5％ )patients fell when turning over ;23 (15.8％ )fell when rising from a seating position ;4(2.7％ )patients fell when showering ;15(10.3％ )patients fell while standing ;9(6.8％ )fell when turning around ;56(38.3％ )fell while walking ;and 12(8.2％ )fell while climbing the stairs or running.The severity of falls :52(35.6％ )patients had no injury ;78(53.2％ ) suffered soft tissue injury ;16 (11.0％ )had fractures ;and 78 (53.2％ )had fear of falling.Multiple Logistic regression analysis showed that age(OR=2.41 ;95％ CI :1.69-3.05) ,history of falls(OR =2.85 ;95％ CI :1.46-3.81) ,history of stroke(OR=1.87 ;95％ CI :1.12-2.79) ,right hemiplegia(OR=2.37 ;95％ CI :1.62-4.59) ,left hemiplegia(OR= 2.47 ;95％ CI :1.46-4.78) ,paraplegia(OR= 2.55 ;95％ CI :1.57-4.98) ,visual impairment(OR=2.35 ;95％ CI :1.35-6.62) ,apraxia(OR=2.53 ;95％ CI :1.42-5.63) ,unilateral spatial neglect (OR=3.34 ;95％ CI :2.82-6.34) ,use of psychotropic medications (OR= 1.76 ;95％ CI :1.11-1.98) ,impaired physical mobility (OR = 1.58 ;95％ CI :1.82-2.91) ,low MMSE scale(OR = 3.42 ;95％ CI :1.38-7.41) ,low Barthel Index score(OR = 2.83 ;95％ CI :0.97-4.68) ,BBS scale<45(OR=2.48 ;95％ CI :1.27-4.18) ,TUG>15seconds(OR=3.56 ;95％ CI :1.91-5.23) ,and lack of rehabilitation therapy (OR=3.42 ;95％ CI :1.38-7.41)were independent predictors for falls(all P<0.05). Conclusions Falls are common among elderly patients within two years after stroke.Most falls happen indoors ,during daytime and while moving.Age ,history of falls ,history of stroke ,hemiplegia ,visual impairment ,apraxia ,unilateral spatial neglect ,use of psychotropic medications ,walk with a walker ,low MMSE scale ,low Barthel Index score ,BBS scale<45 ,TUG>15 seconds ,and lack of rehabilitation therapy are independent risk factors for falls after stroke.
展开▼
