發(fā)布時(shí)間：2018-08-24 08:01

【摘要】：目的本研究通過在住院跌倒高風(fēng)險(xiǎn)老年患者的臨床治療中引入老年綜合評(píng)估(Comprehensive Geriatric Assessment,CGA)及干預(yù),觀察CGA及干預(yù)在降低老年患者的跌倒風(fēng)險(xiǎn)、降低跌倒發(fā)生率、緩解老年患者的跌倒恐懼心理、改善平衡能力、提高患者生存質(zhì)量等方面的作用,為推進(jìn)CGA及干預(yù)在老年患者中的臨床應(yīng)用提供依據(jù)。方法選取2015年10月至2016年9月就住于華北理工大學(xué)附屬醫(yī)院老年病科的年齡≥60歲的老年患者進(jìn)行跌倒風(fēng)險(xiǎn)量表評(píng)估,將最終篩查出的224例跌倒評(píng)分等級(jí)為高風(fēng)險(xiǎn)的患者作為研究對(duì)象,采用隨機(jī)分組的方法分成干預(yù)組和對(duì)照組,每組患者112例,其中對(duì)照組男性48例,女性64例,平均年齡77.18±7.76歲;干預(yù)組男性51例,女性61例,平均年齡76.46±7.37歲。對(duì)入選患者進(jìn)行兩次跌倒風(fēng)險(xiǎn)評(píng)估、平衡能力的評(píng)估、跌倒效能量表評(píng)估及生存質(zhì)量評(píng)估,分別于入院2日內(nèi)及干預(yù)3個(gè)月時(shí)完成,記錄各項(xiàng)評(píng)分結(jié)果。評(píng)估時(shí)同時(shí)采集患者的姓名、性別、年齡、婚姻狀況、職業(yè)、吸煙飲酒情況等一般個(gè)人資料,收集血糖、血脂、血壓、電解質(zhì)、患病情況等醫(yī)學(xué)資料。對(duì)照組患者給予常規(guī)的住院診療、健康知識(shí)教育及常規(guī)的醫(yī)學(xué)護(hù)理,干預(yù)組在上述診療及護(hù)理措施的基礎(chǔ)上,實(shí)施老年綜合評(píng)估及干預(yù)的內(nèi)容,患者出院后每2周進(jìn)行電話隨訪1次,隨訪的內(nèi)容主要為對(duì)干預(yù)措施的執(zhí)行情況、是否有新的需要干預(yù)的問題,干預(yù)執(zhí)行3個(gè)月后對(duì)干預(yù)組患者進(jìn)行第二次CGA評(píng)估,詳細(xì)記錄兩次評(píng)估的結(jié)果。使用Excel 2013軟件建立數(shù)據(jù)庫,應(yīng)用SPSS21.0統(tǒng)計(jì)學(xué)軟件進(jìn)行統(tǒng)計(jì)數(shù)據(jù)分析,計(jì)數(shù)資料采用例數(shù)和百分比進(jìn)行表示,兩組之間的比較采用X2檢驗(yàn);計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差((?)±s)來表示,兩組間及組內(nèi)比較采用t檢驗(yàn),認(rèn)為P0.05為差異具有統(tǒng)計(jì)學(xué)意義。結(jié)果1兩組患者在性別、年齡、婚姻狀況、文化水平、吸煙、飲酒等基礎(chǔ)資料方面進(jìn)行比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組的空腹血糖、血壓、總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、體重指數(shù)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2兩組患者入院時(shí)的跌倒風(fēng)險(xiǎn)評(píng)分進(jìn)行比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05),提示兩組間具有可比性。研究結(jié)束后兩組患者跌倒風(fēng)險(xiǎn)評(píng)分與入院時(shí)比較均有所降低,干預(yù)組與對(duì)照組相比下降更明顯(P0.01)。3干預(yù)結(jié)束后兩組患者跌倒發(fā)生率比較,干預(yù)組跌倒的發(fā)生率明顯低于對(duì)照組,兩組差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4兩組患者平均住院日比較,干預(yù)組明顯低于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。5兩組患者入院時(shí)的BBS評(píng)分相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。研究后兩組患者的評(píng)分與研究之前比較,均有所改善(P0.05),干預(yù)組較對(duì)照組明顯升高,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。6兩組患者入院時(shí)的MFES評(píng)分相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。研究后兩組患者的評(píng)分較研究前均有所改善(P0.05),干預(yù)組與對(duì)照組相比升高更明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。7兩組患者研究前生存質(zhì)量各個(gè)方面的評(píng)分相比,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)束后,對(duì)照組僅在軀體疼痛、情感職能、社會(huì)功能及總分方面與研究前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),干預(yù)組生存質(zhì)量各項(xiàng)評(píng)分較研究前均有所增加(P0.05),且與對(duì)照組相比增加更明顯,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論1老年綜合評(píng)估及干預(yù)應(yīng)用于住院跌倒高風(fēng)險(xiǎn)的老年患者,可以有以下效果:1)降低患者的跌倒風(fēng)險(xiǎn)評(píng)分及跌倒發(fā)生率。2)改善患者的平衡能力、緩解患者的恐懼跌倒心理。3)降低患者的平均住院日。4)提高老年患者的生存質(zhì)量。
[Abstract]:Objective To observe the effects of CGA and intervention on reducing the risk of falls, reducing the incidence of falls, alleviating the fear of falls, improving the balance ability and improving the balance ability of elderly patients. Methods From Oct. 2015 to Sept. 2016, 224 elderly patients aged 60 or older in the geriatric department of the Affiliated Hospital of North China University of Technology were selected and evaluated by the Fall Risk Scale. High-risk patients were randomly divided into intervention group and control group, with 112 patients in each group, including 48 males and 64 females, with an average age of 77.18 [7.76]; 51 males and 61 females, with an average age of 76.46 [7.37], in the intervention group. Assessment, Fall Effectiveness Scale Assessment and Quality of Life Assessment were completed within 2 days after admission and 3 months after intervention, and the results were recorded. Material: Patients in the control group were given routine hospitalization, health education and routine medical care. On the basis of the above-mentioned diagnosis, treatment and nursing measures, the intervention group was given the contents of comprehensive evaluation and intervention for the elderly. The patients were followed up by telephone every two weeks after discharge. The main contents of the follow-up were the implementation of the intervention measures and whether there were any new ones. The second CGA evaluation was conducted three months after the intervention, and the results of the two evaluations were recorded in detail. Excel 2013 software was used to establish a database and SPSS21.0 statistical software was used to analyze the statistical data. The counting data were expressed by the number and percentage of cases. The comparison between the two groups was performed by X2 test. Results 1 There was no significant difference in sex, age, marital status, educational level, smoking and drinking between the two groups (P 0.05). There was no significant difference in blood pressure, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, uric acid, and body mass index between the two groups (P 0.05). There was no significant difference in the fall risk score between the two groups at admission (P 0.05), suggesting that there was comparability between the two groups. Compared with the control group, the incidence of falls in the intervention group was significantly lower than that in the control group (P 0.01). 3 Compared with the control group, the incidence of falls in the intervention group was significantly lower than that in the control group. Statistical significance (P 0.01). 5 There was no significant difference in BBS scores between the two groups at admission (P 0.05). After the study, the scores of the two groups were improved compared with those before the study (P 0.05). The intervention group was significantly higher than the control group, the difference was statistically significant (P 0.01). 6 There was no statistical difference in MFES scores between the two groups at admission. Significance of learning (P 0.05). After the study, the scores of the two groups were improved (P 0.05). Compared with the control group, the scores of the intervention group increased more significantly, the difference was statistically significant (P 0.01). 7 There was no significant difference between the two groups in all aspects of quality of life before the study (P 0.05). After the study, the control group only had somatic pain. There were significant differences in emotional function, social function and total score between the intervention group and the pre-study group (P 0.05). The scores of quality of life in the intervention group increased (P 0.05), and increased more significantly than the control group, the difference was statistically significant (P 0.05). Conclusion 1 The comprehensive evaluation and intervention of the elderly for the high risk of fall in hospitalization. Elderly patients, can have the following effects: 1) reduce the risk score of falls and the incidence of falls. 2) improve the balance of patients, ease the fear of falls. 3) reduce the average hospitalization days of patients. 4) improve the quality of life of elderly patients.
【學(xué)位授予單位】：華北理工大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 李文杰;李沫;郝智慧;母海艷;呂繼輝;;跌倒風(fēng)險(xiǎn)評(píng)估及多學(xué)科團(tuán)隊(duì)干預(yù)對(duì)住院阿爾茨海默病患者跌倒的作用評(píng)價(jià)[J];實(shí)用老年醫(yī)學(xué);2016年04期

2 楊琛;王秀華;谷燦;劉莉;;老年人健康綜合評(píng)估量表研究現(xiàn)狀及進(jìn)展[J];中國全科醫(yī)學(xué);2016年09期

3 顧媛媛;吳金鳳;梅克文;;老年綜合評(píng)估的概念及研究進(jìn)展[J];護(hù)理實(shí)踐與研究;2016年01期

4 金鶴;潘乃林;錢桂香;袁莉;李婷婷;;黃浦區(qū)西片社區(qū)腦卒中患者跌倒原因調(diào)研[J];上海醫(yī)藥;2015年18期

5 李婉妮;徐盈;李璽;宋美利;劉珊珊;李涵;;綜合干預(yù)方法防治老年患者跌倒的效果評(píng)價(jià)[J];安徽醫(yī)學(xué);2015年09期

6 馮艷;;老年癌癥患者生存獲益基于老年綜合評(píng)估護(hù)理多學(xué)科實(shí)踐研究[J];中外醫(yī)療;2015年05期

7 胡麗芳;;住院患者跌倒原因分析與對(duì)策[J];基層醫(yī)學(xué)論壇;2014年32期

8 高茂龍;宋岳濤;;中國老年人跌倒發(fā)生率meta分析[J];北京醫(yī)學(xué);2014年10期

9 王文蘭;黎月英;馮錦屏;何燕君;伍惠鳳;陸嘉欣;;住院患者跌倒風(fēng)險(xiǎn)評(píng)估量表的修訂與信度、效度檢驗(yàn)[J];中國護(hù)理管理;2014年09期

10 鄭蝶梅;;住院老年患者跌倒因素分析及防范措施[J];齊魯護(hù)理雜志;2014年15期

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