血液病患者跌倒危险因素及风险预测研究分析

Clinical study of falls in hospitalized patients with hematological diseases

目的:探讨血液病住院患者跌倒相关的危险因素及跌倒风险评估模型的预测价值。方法:采用回顾性分析法选取2019年9月至2021年8月在绵阳市中心医院血液科住院治疗且病历资料完整的跌倒患者70例及同期非跌倒的72例。收集所有患者的临床信息和可能引起跌倒的一些相关因素,同时对所有患者进行6种跌倒风险量表评分,采用单因素、多因素Logistic回归分析进行影响因素分析,ROC曲线分析法评价不同跌倒风险评分量表对血液病住院患者跌倒的预测价值。结果:(1)与非跌倒组相比,跌倒组疾病确诊数量、如不包括其他系统肿瘤,建议:患(急、慢)性白血病和亚性淋巴、伴夜尿增多、伴头昏、接受化疗、使用利尿剂、泻药、镇静安眠药、留置导管、血糖的比例更高(P<0.05),有陪护、血清白蛋白、血清钾、血清钙较低(P<0.05);(2)多因素Logistic回归分析显示:合并症(或并发症)多(P<0.001)、使用利尿剂(P<0.05)、接受化疗(P<0.05)是跌倒的独立影响因素,高自理能力(P<0.05)和有陪护(P<0.05)是跌倒的保护性因素;(3)ROC曲线分析法评价不同跌倒风险评分量表对血液病住院患者跌倒的预测价值,约翰霍普金斯跌倒危险评定量表诊断价值最大,AUC为0.759(95%CI 0.675~0.843,P<0.001)。结论:对于合并症(或并发症)多、使用利尿剂和接受化疗的血液病患者,可通过陪护或提高自理能力来降低跌倒风险;约翰霍普金斯跌倒危险评定量表具有较好的跌倒风险预测价值,可作为有效预测血液病住院患者跌倒的评估工具。

Objective:To explore the risk factors of falls in hospitalized patients with hematological diseases and the predictive value of the fall risk assessment model.Methods:A retrospective analysis was used to select 70 patients with falls and 72 patients without falls who were hospitalized in the Department of Hematology of Mianyang Central Hospital from September 2019 to August 2021 with complete medical records.At the same time,all patients were scored by fall risk scale.Single factor and multivariate Logistic regression analysis were used to analyze the influencing factors.Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of different fall risk score scales for falls in hospitalized patients with hematological diseases.Results:(1)Compared with the non-fall group,the number of disease diagnoses,the proportion of tumor diseases(leukemia and lymphoma),nocturia,dizziness,chemotherapy,use of diuretics,laxatives,sedative and hypnotics,indwelling catheter and blood glucose were higher in the fall group(P<0.05),and the number of accompanying persons,serum albumin,serum potassium and serum calcium were lower in the fall group(P<0.05).(2)Multivariate Logistic regression analysis showed that more comorbidities(P<0.001),use of diuretics(P<0.05)and chemotherapy(P<0.05)were independent influencing factors for falls,while high self-care ability(P<0.05)and having caregivers(P<0.05)were protective factors for falls.(3)Receiver operating characteristic(ROC)curve analysis was used to evaluate the predictive value of different fall risk score scales for falls in hospitalized patients with hematological diseases.Johns Hopkins Fall risk assessment Scale had the largest diagnostic value,with an AUC of 0.759(95%CI 0.675~0.843,P<0.001).Conclusions:For blood disease patients with many complications,using diuretics and receiving chemotherapy,the risk of falls can be reduced by accompanying or improving self-care ability.Johns Hopkins Fall risk assessment Scale has a good predictive value for fall risk,which can be used as an assessment tool to effectively predict the fall risk of hospitalized patients with hematologic diseases.