临床医学脑卒中后跌倒的流行病学及病理生理学

Epidemiology and Pathophysiology of Falls in Individuals with Stroke

脑卒中生存者存在跌倒的风险,跌倒在生理及精神上可导致严重后果。脑卒中可使髋部骨折的危险增高,髋部骨折后,患者难以恢复到病前独立运动能力。害怕跌倒在跌倒后常见,可引起活动减少,抑郁甚至独立运动能力降低。跌倒最重要的危险因子为平衡障碍及步态障碍,脑卒中相关的平衡障碍包括静态平衡、动态平衡、他动动态平衡受损,步态异常包括平地行走、复杂行走的技巧能力下降,髋部及膝部复合性运动减少,稳定性减少而发生跌倒。

Stroke survivors are at high risk for falls in all poststroke stages. Falls may have severe conse-quences, both physically and psychologically. Individuals with stroke have an increased risk for hip fractures, and after such a fracture, they less often regain independent mobility. In addition, fear of falling is a common consequence of falls, which may lead to decreased physical activity, social deprivation and, eventually, loss of independence. Important risk factors for falls are balance and gait disorders. Stroke-related balance disorder comprise quiet stance perturbations, self-induced perturbations and external balance perturbations. Gait abnormalities include reduced propulsion at level walking, complex walking skills, decreased hip and knee flexion, and reduced stability resulted falls.