老年住院病人跌倒伤害事件的特征及影响因素分析

doi:10.3969/j.issn.1003-9198.2024.01.019

摘要/Abstract

摘要： 目的探讨60岁及以上病人在院期间发生跌倒不良事件后的伤害程度分布特点,分析其与年龄、实验室指标的相关性。方法回顾性收集2017～2021年在南京医科大学第一附属医院发生跌倒不良事件病人(年龄≥60岁)的临床资料,根据其跌倒后的伤害程度将其分为无伤害组、一级伤害组、二级伤害组、三级伤害组。收集入组病人发生跌倒不良事件前7 d内最近一次晨空腹生化、凝血指标、血常规检测结果,分析不同跌倒伤害程度住院老年病人基本资料、实验室指标的差异。采用Spearman相关系数表示不同指标间的相关性;采用二元Logistic回归分析老年住院病人跌倒发生伤害的影响因素。结果 382例老年住院病人跌倒伤害程度分布以一级伤害(150例,39.27%)为主,其次为无伤害(145例,37.96%)、三级伤害(52例,13.61%)、二级伤害(35例,9.16%)。单因素分析显示,不同跌倒伤害程度老年病人的年龄、凝血酶原时间(PT)、国际标准化比值(INR)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)水平差异有统计学意义(P＜0.05或P＜0.01)。Spearman相关分析显示,老年住院病人的跌倒伤害程度与年龄、PT、INR、APTT、FIB均呈正相关(r=0.188、0.169、0.177、0.147、0.131,均P＜0.05)。Logistic回归分析显示,年龄(OR=1.035)、FIB(OR=1.330)为老年住院病人跌倒发生伤害的独立影响因素。结论老年住院病人跌倒后伤害程度与年龄、凝血功能存在关联,建议将该部分高伤害风险人群作为跌倒风险管理的切入点,实施分层管理。

关键词: 老年人, 跌倒, 伤害程度, 凝血功能, 住院病人

Abstract: Objective To investigate the distribution characteristics of injury degree caused by falls in the elderly inpatients, and to analyze the influencing factors. Methods The clinical data of 382 inpatients aged ≥60 years old who had fallen in the First Affiliated Hospital of Nanjing Medical University from 2017 to 2021 were retrospectively collected. According to the degree of injury caused by falls, they were divided into no injury group, first-level injury group, second-level injury group and third-level injury group. Fasting biochemical factors, coagulation indexes and blood routine test results of the latest morning within 7 days before falls were collected and compared among the groups. The correlation between different indicators was represented by Spearman correlation coefficient. The risk factors of injury caused by falls in the elderly inpatients were analyzed by binary Logistic regression analysis. Results Among the 382 elderly inpatients, the main injury degree was first-level injury (n=150, 39.27%), followed by no injury (n=145, 37.96%), third-level injury (n=52, 13.61%) and second-level injury (n=35, 9.16%). Univariate analysis showed that there were significant differences in age, prothrombin time (PT), international standard ratio (INR), activated partial thrombin time (APTT), fibrinogen (FIB) among the elderly patients with different degrees of injury caused by falls (P＜0.05 or P＜0.01). Spearman correlation analysis showed that the degree of injury caused by falls in the hospitalized elderly patients was positively correlated with age, PT, INR, APTT and FIB (r=0.188, 0.169, 0.177, 0.147, 0.131, all P<0.05). Logistic regression analysis showed that age (OR=1.035) and FIB (OR=1.330) were the independent influencing factors of injury caused by falls. Conclusions The degree of injury caused by falls is associated with age and coagulation function in the elderly inpatients, and the population with high risk of injury should receive hierarchical management.

Key words: aged, falls, degree of injury, coagulation function, inpatient

中图分类号:

R 592

朱姣, 夏丽莉, 许敏铮, 刘滢, 王迎欣, 尤征媛. 老年住院病人跌倒伤害事件的特征及影响因素分析[J]. 实用老年医学, 2024, 38(1): 81-85.

ZHU Jiao, XIA Lili, XU Minzheng, LIU Ying, WANG Yingxin, YOU Zhengyuan. Analysis of characteristics and influencing factors of fall injury in hospitalized elderly patients[J]. Practical Geriatrics, 2024, 38(1): 81-85.

参考文献

[1] 王玉梅, 李凌, 熊莉娟, 等. 老年人跌倒预防临床实践指南的质量评价及内容分析[J]. 中华护理杂志, 2019, 54(11): 1729-1734.
[2] 王颖, 尹世玉, 郭晓贝, 等. 住院患者预防跌倒安全屏障的建立与实践[J]. 护理学报, 2019, 26(15): 14-17.
[3] NAJAFPOUR Z, GODARZI Z, ARAB M, et al. Risk factors for fallsin hospital in-patients: a prospective nested case control study[J]. Int J Health Policy Manag, 2019, 8(5): 300-306.
[4] 吴志军, 尚文涵, 简伟研, 等. 我国住院患者跌倒发生率现状分析: 基于490家三级甲等医院的调查[J]. 中国卫生质量管理, 2019, 26(3): 14-17.
[5] 胡依, 郭芮绮, 闵淑慧, 等. 1990-2019年中国老年人群跌倒疾病负担分析[J]. 现代预防医学, 2021, 48(9): 1542-1545.
[6] 张春华, 毛德强, 肖义夫, 等. 重庆市65岁及以上老人伤害死亡特征及趋势分析[J]. 公共卫生与预防医学, 2020, 31(6): 79-82.
[7] 北京协和医院世界卫生组织国际分类家族合作中心. 疾病和有关健康的国际统计分类第十次修订本[M]. 北京: 人民卫生出版社, 2010:220-267.
[8] 倪平, 陈京立, 刘娜. 护理研究中量性研究的样本量估计[J]. 中华护理杂志, 2010, 45(4): 378-380.
[9] 詹亚, 何鑫, 蒲蕾, 等. 血液透析患者高钾血症季节分布特征研究[J]. 中国实用内科杂志, 2022, 42(1): 60-63.
[10] 么莉. 护理敏感性质量指标实用手册[M]. 北京: 人民卫生出版社, 2016:91-92.
[11] 吴志军, 尚文涵, 简伟研, 等. 我国住院患者跌倒发生率现状分析: 基于490家三级甲等医院的调查[J]. 中国卫生质量管理, 2019, 26(3): 14-17.
[12] 赵敏, 苏晓霞, 李曙光, 等. 基于关联规则的老年住院患者跌倒伤害事件发生特征分析[J]. 护理学杂志, 2020, 35(18): 61-64.
[13] 郭雁飞, 马文军, 张庆军, 等. 中国8个省份50岁及以上人群跌倒伤害及其危险因素横断面研究[J]. 中华流行病学杂志, 2018, 35(3): 258-263.
[14] 黄丽红, 徐为民, 刘敏, 等. 住院老年患者肌少症危险因素研究[J]. 中国实验诊断学, 2018, 22(1): 48-52.
[15] 皮红英, 库洪安, 赵婷.下肢肌力训练对老年人平衡及运动能力的影响[J]. 解放军护理杂志, 2017, 34(12): 51-54.
[16] 林进龙, 魏玥, 陈功, 等. 慢性病对中老年人跌倒伤害影响的队列研究[J]. 中华流行病学杂志, 2022, 43(2): 218-226.
[17] 闻贤强, 颜艾. 凝血指标对颅脑损伤患者病情程度和预后的影响[J]. 中国现代医生, 2021, 59(30): 77-80.
[18] 秦丽, 杨威威, 孙锡红, 等. 产前血浆纤维蛋白原联合血栓弹力图检测与产后出血关系[J]. 河北医药, 2019, 41(22): 3441-3443, 3447.
[19] DU X G, DONG B Z, LI C, et al. Dynamic changes of α-melanocyte-stimulating hormone levels in the serum of patients with craniocerebral trauma[J]. Exp Ther Med, 2017, 14(3): 2511-2516.
[20] 薛红梅, 刘安梅. 颅脑外伤患者凝血功能对预后的影响研究[J]. 延安大学学报(医学科学版), 2017, 15(1): 35-38.
[21] 刘玉萍, 刘梅娟, 吴家岚, 等. 消化内科住院患者跌倒危险因素的病例对照研究[J]. 现代消化及介入诊疗, 2022, 27(2): 260-264.
[22] 张宇, 李新, 冷晓, 等. 低钠血症与跌倒、骨质疏松及骨折的相关性[J]. 中华老年病研究电子杂志, 2018, 3:41-44.