老年患者全髋关节置换术后跌倒预防的最佳证据总结

Summary of best evidence for fall prevention after total hip arthroplasty in elderly patients

目的检索并总结老年患者全髋关节置换术后跌倒预防的最佳证据。方法系统检索BMJ Best Practice、UpToDate、JBI循证卫生保健中心数据库、英国国家临床医学研究所指南库网站、苏格兰校际指南网站、Cochrane Library、PubMed、Web of Science、EBSCO、国际骨科护士协作会网站、美国骨科医师协会网站、欧洲创伤与急诊外科学会网站、医脉通、中国知网、万方、维普、中国生物医学文献数据库,检索时间为建库至2024年6月30日。对文献质量进行评价,并对证据进行提取、评价及汇总。结果共纳入12篇文献,其中指南4篇,随机对照试验2篇,队列研究2篇,专家共识4篇。共计提取18条证据,其中A级推荐13条,B级推荐5条,证据涵盖危险因素、评估、多学科团队保障、健康教育、用药管理、安全环境和辅具六大主题。结论老年患者全髋关节置换术后跌倒的预防涉及多方面因素,其跌倒预防工作应以多学科团队合作为前提,实现院内与家庭的联动,共同保障患者安全。未来,建议在证据应用时可结合患者个体差异与实际临床场景。

Objective To retrieve and summarize the best evidence for fall prevention after total hip arthroplasty in elderly patients.Methods BMJ Best Practice,UpToDate,JBI evidence-based healthcare center database,National Institute for Health and Clinical Excellence,Scottish Intercollegiate Guidelines Network,Cochrane Library,PubMed,Web of Science,EBSCO,International Collaboration of Orthopaedic Nurisng website,American Academy of Orthopaedic Surgeons website,European Society for Trauma and Emergency Surgery website,Medlive,China National Knowledge Infrastructure,Wanfang,Chongqing VIP,and SinoMed were systematically searched.The retrieval time was from the establishment of the databases to June 30,2024.The quality of literature was evaluated,and evidence was extracted,evaluated,and summarized.Results A total of 12 articles were included,including 4 guidelines,2 randomized controlled trials,2 cohort studies,and 4 expert consensus studies.A total of 18 pieces of evidence were extracted,including 13 A-level recommendations and 5 B-level recommendations.The evidence covers six major themes of risk factors,assessment,multidisciplinary team support,health education,medication management,safety environment,and assistive devices.Conclusions The fall prevention after total hip arthroplasty in elderly patients involves multiple factors,and the fall prevention should be based on multidisciplinary team cooperation,achieving linkage between the hospital and the family to jointly ensure patient safety.In the future,it is recommended to combine individual patient differences with actual clinical scenarios when applying evidence.