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

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