外科老年患者围术期跌倒风险评估的研究

Fall risk assessment among surgical elderly during perioperative period

目的描述外科老年患者围术期不同时间的跌倒风险，探讨跌倒风险评估的最佳时间及其相应的影响因素。方法采用便利取样法选择外科择期手术的老年患者250例，运用美国约翰霍普金斯跌倒风险评估量表对其进行跌倒风险评估。患者入院当天进行第1次评估，然后每天1次直至术后第7天。结果患者手术前1d跌倒风险增大，手术当天跌倒风险最高为（13．92±1．94）分，且与其他时间段比较，差异有统计学意义（F=142．25；P〈0．01）。术后2d内跌倒风险较高，均值分别为（12．87±1．42），（11．98±2．15）分。术后第3天至第7天患者跌倒风险评分比较平稳，均为中等风险。相关分析结果显示：术后3d内药物、护理设施的Pearson系数分别〉0．5，而术后第2天至第7天移动的Pearson系数〉0．5。通过进一步回归分析结果显示，药物、移动、患者的护理设施及患者存在跌倒史是患者围术期跌倒风险的高危因素。结论术前1d跌倒风险增大，手术完毕回病房后跌倒风险达高峰，术后7d内患者跌倒风险递减但仍为中度风险，不同的时间存在不同的高风险因素，提示外科护理应该加强术前1d、术日返回病房及术后7d的老年患者的跌倒风险评估与预防，降低跌倒发生率。

Objective To address the fall risks in surgical patients during different time of perioperative period, and explore the best time of risk assessment, and its influencing factors. Methods A total of 250 elderly, who had selective operation and were chosen by a convenient sampling method, received fall risk assessment by Johns Hopkins fall risk assessment tool. We assessed the fall risk factors once a day from the first day of hospitalization until the seven day after operation. Results The fall risk increased 1 d before operation, and it climbed the highest score on the operation day （13.92 ＋ 1.94） with statistical significant compared with fall risk of other day （ P 〈 0.01 ）. The average score of fall risk were （ 12.87 ~ 1.42 ）, （ 11.98 ＋ 2.15 ） in two days after operation having high fall risk. From 3 d to 7 d after operation, the score of fall risk maintained a medium level. By correlation analysis, it presented the Pearson coefficient was 〉 0.5, for medicine and nursing facilities of 3 d after operation, and the movement of Pearson coefficient was 〉 0.5 during the 2 d to 7 d after operation. The further outcome of regression analysis shew that medicine, movement, patient＇s nursing facilities and the fall history were high risk factors during perioperative period. Conclusions The fall risk increases on one day before operation and reach peak when patients come back unit after operation. After 7 d operation, the score of fall risk decreases progressively, but it still stays at the medium level. Different time exists different high fall risk factors, and it indicates we should strengthen fall risk assessment and prevention at 1 d, day coming back unit after operation and 7 d after operation to prevent fall incidences.