3个专科住院患者跌倒高危因素比较及对策

Falls Risk Factors of Inpatients in 3 Different Departments and Related Interventions

目的分析泌尿外科、神经内科和心内科3个不同专科跌倒高危患者危险因素的异同点,探讨有专科特色的预防对策。方法建立改良跌倒危险因素评估表(灵敏度达82.61%,特异度达77.00%),将评分≥4分者定为跌倒高危患者,分析比较2009年7—9月3个不同专科共677例跌倒高危患者危险因素的分布情况。结果泌尿外科、神经内科和心内科3个不同专科跌倒高危患者中存在头晕或体位性低血压这一因素的均在51.0%左右(P>0.05)。3个专科跌倒高危患者其他高危因素比较差异均有统计学意义,其中泌尿外科跌倒高危患者中55.2%有听力障碍,既往有跌倒史和依从性差者分别达到了29.9%和10.3%;神经内科跌倒高危患者中63.7%的患者移动时需帮助,且有认知或意识障碍等的患者共占9.1%;心内科跌倒高危患者中85.8%有服药史,主要为服用降压利尿药等药物。另外,3个专科在年龄这一危险因素的比较上差异也有统计学意义,但存在年龄这一危险因素的比例均较高,分别为96.6%、74.6%、81.7%。结论泌尿外科、神经内科和心内科3个不同专科跌倒高危患者危险因素不尽相同,应根据不同专科特点实施有专科特色的预防措施,如对泌尿外科跌倒高危患者应加强巡视和看护,加强沟通和交流,反复宣讲以提高患者的依从性;对神经内科跌倒高危患者应重点指导改变体位及移动的方法,行走时给予准确扶助,卧床时防止坠床等;而心内科患者应加强用药指导和护理,如用利尿剂时给予如厕协助和指导,服降压药时给予改变体位指导等。

Objective To compare the similarities and differences of falls risk factors in department of urology, neurology and cardiology and to explore distinct prevention measures in different departments. Methods Patients with main falls risk factors were identified with Improved Falls Risk Factor Scale which was developed with a sensitivity of 82.61% and a specificity of 77.00%. Risk factors collected from 677 patients were compared. Results About 51.0% of the patients had the risk factor of dizziness or orthostatic hypotension （P〉0.05）. There was statistic significance of the comparisons among other risk factors in these three departments. In Urology, 55,2% of the patients suffered from hearing impairment, and 29.9% once experienced falls while 10.3% were with weak compliance. In neurology, 63.7% of the patients needed help while moving but in cardiology, 85.8% of the patients had taken medication. Meanwhile, age played a critical role in falls. Conclusion Different falls risk factors exist in these three departments, as a result, various prevention measures should be adopted based on characteristics of falls risk factors in each department.