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目的探讨经康复治疗出院的老年脑卒中患者家居1年跌倒的发生率、地点及预测因子。方法选取南宁市第八人民医院神经内科2014年1月1日至2015年6月30日因脑卒中住院、并经康复治疗出院后家居患者80例及年龄、性别匹配的健康对照者98例,应用Berg平衡量表(BBS)评估平衡功能,计时起走测试(TUG)量表以及6 min步行试验(6MWT)量表评估运动功能,平衡信心(ABC)量表评估平衡信心。随访1年,记录两组患者跌倒的特点,应用Chi-square检验比较两组跌倒的地点,应用负二项回归分析法分析两组患者跌倒的发生率及预测因子。结果卒中组跌倒共109例次,明显高于对照组的70例次(U=15.332,P<0.001),卒中组跌倒发生率为50%,平均跌倒发生率为每年1.36次/人;卒中组基线简易智力状态检查量表(MMSE)评分23(11,30)分,BBS评分(46.1±8.3)分,6MWT(275.9±141.8)m,ABC评分(62.7±24.2)分,TUG(20.5±14.3)s,对照组MMSE评分28(22,30)分,BBS评分(55.8±3.6)分,6MWT(527.8±85.9)m,ABC评分(93.2±10.9)分,TUG(8.5±1.9)s。卒中组基线MMSE评分、BBS评分、6MWT评分、ABC评分均低于对照组,TUG高于对照组,差异均具有统计学意义(U=13.567,t=15.876、19.512、20.221、20.154,均P<0.001);脑卒中组跌倒的发生率是对照组的1.767倍,脑卒中是跌倒的预测因素;卒中组家中跌倒率(75%)明显高于对照组(36%)(χ~2=19.71,P<0.001);BBS与卒中组及对照组跌倒均相关(IRR分别为0.908及0.777),TUG与卒中组跌倒相关(IRR为0.955),6MWT与对照组跌倒相关(IRR为1.004),ABC与脑卒中组及对照组均无相关性。结论经康复治疗出院的家居老年脑卒中患者1年家中跌倒的风险较对照组高,应注意家中的环境,平衡功能是卒中组及对照组患者跌倒的预测因素,运动增多可增加跌倒的机会。
Objective To investigate the incidence, location and predictors of one-year home-falls in elderly stroke patients who were discharged after rehabilitation. Methods Eighty-eight home-based patients and 98 healthy controls matched for age and sex were discharged from Neurology Department of Eighth People’s Hospital of Nanning City from January 1, 2014 to June 30, 2015 after stroke hospitalization. Balance performance was assessed using the Berg Balance Scale (BBS), the TUG Timing Scale, and the 6-Minute Walk Test (6MWT) scale, and the Balance Confidence (ABC) scale to assess the balance confidence. The patients were followed up for 1 year. The characteristics of falls in both groups were recorded. Chi-square test was used to compare the fall sites. The negative binomial regression analysis was used to analyze the incidence and predictors of falls in both groups. Results A total of 109 falls in the stroke group were significantly higher than 70 in the control group (U = 15.332, P <0.001). The incidence of falls in the stroke group was 50% and the average incidence of falls was 1.36 times per year in the stroke group. MMSE scores of 23 (11,30), BBS (46.1 ± 8.3), 6MWT (275.9 ± 141.8) m, ABC score of 62.7 ± 24.2, TUG of 20.5 ± 14.3 ), MMSE score of 28 (22,30), BBS score (55.8 ± 3.6), 6MWT (527.8 ± 85.9) m, ABC score of 93.2 ± 10.9 and TUG of 8.5 ± 1.9 s in the control group. Baseline MMSE score, BBS score, 6MWT score and ABC score in the stroke group were lower than those in the control group, and TUG was higher than that in the control group (P <0.05, t = 15.876, 19.512, 20.221 and 20.154, respectively) 0.001). The incidence of fall in stroke group was 1.767 times that in control group, and stroke was the predictor of fall. The home-fall rate (75%) in stroke group was significantly higher than that in control group (36%) (χ ~ 2 = 19.71, (IRR = 0.908 and 0.777, respectively), TUG was associated with fall in stroke group (IRR = 0.955), 6MWT with fall in control group (IRR = 1.004) Stroke group and control group no correlation. Conclusion The home-based stroke patients who were discharged from hospital after rehabilitation were at higher risk of falling home at one year than those in the control group. Attention should be paid to the environment at home. Balance function was a predictor of falls in both stroke and control subjects. Increased exercise may increase the chances of falls.