急性冠脉综合征住院患者跌倒风险评估及影响因素分析

Risk assessment and influencing factors of fall in hospitalized patients with acute coronary syndrome

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1732例ACS患者,其中低危风险组患者156例(9.0%),中高危风险组1576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。

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 1732 ACS patients were enrolled.Medium/high-risk fall was present in 1576 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.