急性冠脉综合征住院患者跌倒风险评估及影响因素分析

doi:10.3761/j.issn.0254-1769.2023.09.009

摘要/Abstract

摘要：

目的评估急性冠脉综合征（acute coronary syndrome，ACS）住院患者的跌倒风险并分析其影响因素。方法基于一项单中心、前瞻性队列研究，选取2015年6月—2020年1月在北京市某三级甲等综合医院的住院ACS患者。由经过培训的主管护师对入组患者采用Morse跌倒评估量表进行评分，依据评分标准将患者分为低危风险组（总分<25分）和中高危风险组（总分≥25分）。采用多元逐步Logistic回归分析其影响因素。结果共纳入1 732例ACS患者，其中低危风险组患者156例（9.0%），中高危风险组1 576例（91.0%）。与低危风险组患者比较，中高危风险组使用降糖、心血管疾病相关药物（抗血小板、降压、降脂）的比例更高（P<0.05）；两组的夜间平均血氧饱和度比较，差异具有统计学意义（P=0.019）；低危风险组较中高危风险组，患者接受单次经皮冠状动脉介入治疗、术中旋磨、接受分次经皮冠状动脉介入治疗的比例更高（P<0.05）。多元Logistic回归分析显示，夜间平均血氧饱和度（RR=1.035，95%CI为1.020~1.048，P=0.043）、年龄（RR=1.040，95%CI为1.021~1.059，P<0.001）、高血压病史（RR=3.177，95%CI为2.215~4.557，P<0.001）、心肌梗死病史（RR=1.751，95%CI为1.009~3.037，P=0.046）、糖尿病病史（RR=1.633，95%CI为1.073~2.579，P=0.046）、体重指数（RR=1.064，95%CI为1.011~1.120，P=0.018）均是跌倒中高风险的独立影响因素。结论在ACS住院患者中，存在跌倒中高风险的患者占比高达91.0%；年龄越大、体重指数越高、既往合并高血压、糖尿病、心肌梗死病史以及夜间平均血氧饱和度越低的患者跌倒风险越高。

关键词: 急性冠脉综合征, 跌倒, 影响因素分析, 护理

Abstract:

Objective To investigate the current status of fall risk in hospitalized patients with acute coronary syndrome（ACS） based on Morse Score Scale，and to analyze the influencing factors. Methods A single-center，prospective cohort study was carried out for investigation. Between June 2015 to January 2020，consecutive ACS patients hospitalized at a tertiary A general hospital in Beijing were enrolled. All patients underwent portable sleep breathing monitoring，and they were then divided into a low-risk fall group（score<25） and a medium/high-risk fall group（score≥25） by Morse Fall Score administered by trained nurses in charge. Multivariate stepwise Logistic regression was used to analyze the influencing factors. Results A total of 1 732 ACS patients were enrolled. Medium/high-risk fall was present in 1 576 patients （91.0%），and 156 patients（9.0%） were in the low risk fall group. The proportion of patients with medium/high-risk of fall combined with hypoglycemic therapy，cardiovascular related drugs（anti-platelet，anti-hypertensive，lipid-lowering） was higher than the low-risk group（P<0.05）. The difference of mean SaO₂ between the 2 groups was statistically significant（P=0.019）. Compared with the medium/high risk fall group，the proportion of patients receiving PCI，coronary rotational atherectomy and multiple PCI was higher in the low-risk fall group（P<0.05）. Multiple linear regression analysis showed that mean SaO₂（RR=1.035， 95%CI 1.020~1.048，P=0.043），age（RR=1.040，95%CI 1.021~1.059，P<0.001），prior hypertension（RR=3.177，95%CI 2.215~4.557，P<0.001），prior myocardial infarction（RR=1.751，95%CI 1.009~3.037，P=0.046），diabetes mellitus （RR=1.633，95%CI 1.073~2.579，P=0.046），and body mass index（RR=1.064，95%CI 1.011~1.120，P=0.018） were the risk factors for medium/high risk falls. Conclusion Among hospitalized ACS patients，the incidence of medium/high risk falls was as high as 91.0%. The risk of falls was higher in patients with older age，higher body mass index，history of hypertension，diabetes，myocardial infarction，and lower the average oxygen saturation at night.

Key words: Acute Coronary Syndrome, Fall, Root Cause Analysis, Nursing Care

相爽, 王宾, 苗华, 韩荆, 姜京京, 郑文, 严研, 王晓, 公威, 艾辉, 阙斌, 聂绍平, 张立新. 急性冠脉综合征住院患者跌倒风险评估及影响因素分析[J]. 中华护理杂志, 2023, 58(9): 1082-1087.

XIANG Shuang, WANG Bin, MIAO Hua, HAN Jing, JIANG Jingjing, ZHENG Wen, YAN Yan, WANG Xiao, GONG Wei, AI Hui, QUE Bin, NIE Shaoping, ZHANG Lixin. Risk assessment and influencing factors of fall in hospitalized patients with acute coronary syndrome[J]. Chinese Journal of Nursing, 2023, 58(9): 1082-1087.

图/表 5

表1 两组急性冠脉综合征患者一般资料的比较

Table 1 Comparison of general data of ACS patients in 2 groups

表2 两组急性冠脉综合征患者既往用药情况的比较[例（百分比，%）]

Table 2 Comparison of previous medication in 2 groups[cases（percentages，%）]

表3 两组急性冠脉综合征患者睡眠情况的比较

Table 3 Comparison of sleep monitoring indicators in 2 groups

表4 两组急性冠脉综合征患者临床特点的比较[例（百分比，%）]

Table 4 Comparison of clinical characteristics in 2 groups[cases（percentages，%）]

表5 急性冠脉综合征患者跌倒中/高风险的影响因素分析

Table 5 Logistic analysis of risk factors of fall in patients with ACS

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