224例维持性血液透析患者跌倒发生率调查及影响因素分析
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摘要
目的了解维持性血液透析患者跌倒发生率,分析跌倒发生基本特征及影响因素,为临床护理制定干预策略提供参考依据。方法采用便利抽样原则,对某三级甲等医院血液净化中心224名接受维持性透析治疗患者进行问卷调查,内容为过去1年内是否发生跌倒,跌倒的场所、原因、部位、受伤及恢复情况;计算发生率并通过多元回归分析跌倒影响因素。结果 224例患者1年内跌倒发生率为20%。跌倒好发地点为马路(28.3%)、家中地面(26%)、卫生间(13%);常见原因为滑倒(38.6%)、身体不适跌倒(36.4%)、绊倒(16%);跌倒部位前3位为腿部(37%)、骶尾部(26%)、头面部(15.2%);受伤情况中15.9%的跌倒导致了骨折或骨裂;大部分患者跌倒后能在3个月内恢复。导致患者跌倒的影响因素有年龄、透析年限、透析中低血压、血红蛋白水平。结论血液透析患者跌倒发生率高,危害后果严重,护士需加强对高龄、透析年限较长、易发生透析中低血压、低血红蛋白水平患者的护理,做好跌倒的评估和预防。
Objectives To understand the incidence of fall, its characteristics and influence factors in maintenance hemodialysis(MHD) patients in order to provide a reference for nursing strategies. Methods A total of 224 MHD patients treated in the blood purification center of a grade Ⅲ hospital from May 2017 to April 2018 and recruited by convenience sampling method were enrolled in this study. A survey was made to investigate fall number in a year, place, main cause and site of the fall(s), injuries due to the falls, and recovery information. The incidence was calculated and the influence factors were analyzed by multivariate regression. Results The incidence of fall was 20% within a year. The fall occurred frequently in street, at home or in toilet room. The falls may cause severe injuries. The influence factors for falls included older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level. Conclusion The incidence of fall was higher in MHD patient. The falls may cause severe injuries. The assessment and prevention of fall and the nursing for falls should be intensified for the MHD patients with older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level
Objectives To understand the incidence of fall, its characteristics and influence factors in maintenance hemodialysis(MHD) patients in order to provide a reference for nursing strategies. Methods A total of 224 MHD patients treated in the blood purification center of a grade Ⅲ hospital from May 2017 to April 2018 and recruited by convenience sampling method were enrolled in this study. A survey was made to investigate fall number in a year, place, main cause and site of the fall(s), injuries due to the falls, and recovery information. The incidence was calculated and the influence factors were analyzed by multivariate regression. Results The incidence of fall was 20% within a year. The fall occurred frequently in street, at home or in toilet room. The falls may cause severe injuries. The influence factors for falls included older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level. Conclusion The incidence of fall was higher in MHD patient. The falls may cause severe injuries. The assessment and prevention of fall and the nursing for falls should be intensified for the MHD patients with older age, longer dialysis period, intradialytic hypotention and lower hemoglobin level
引文
[1]Desmet C,Beguin C,Swine C,et al.Falls in hemodialysis patients:Prospective study of incidence,risk factors,and complications[J].Am.J.Kidney Dis.Jan,2005,45(1):148-153.
[2]Cook WL,Tomlinson G,Donaldson M,et al.Falls and fall-related injuries in older dialysis patients[J].Clin.J.Am.Soc.Nephrol.Nov,2006,1(6):1197-1204.
[3]Delgado C,Shieh S,Grimes B,et al.Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis[J].Am.J.Nephrol,2015,42(2):134-140.
[4]Bowling CB,Hall R,Khakharia A,et al.Serious fall injury history and adverse health outcomes after initiating hemodialysis among older U.S.adults.The journals of gerontology.Series A,Biological sciences and medical sciences[J].2018 Jan 16(Epub 2018 Jan 2018).
[5]Abedi Yekta AH,Fatollahierad S,Hassabi M,et al.Fall Incidence and Risk Factors in Hemodialysis Patients[J].Turk.Nephrol.Dial.Transplant.J,2016,25(3):263-268.
[6]Rocha,A,Sousa C,Teles P,et al.Frequency of intradialytic hypotensive episodes:old problem,new insights[J].J Am Soc Hypertens,2015,9(10):763-768.
[7]魏丽君,黄惠根,钟杏,等.住院患者跌倒造成损伤的相关因素分析[J].护理研究,2016(4):406-410.
[8]冯志仙,黄丽华,胡斌春.住院患者跌倒造成伤害的风险因素分析[J].中华护理杂志,2013(4):323-327.
[9]袁泉,姚文兵.老年人跌倒的影响因素及预防措施[J].中国老年学杂志,2017(17):4373-4375.
[10]孙丽.透析年限对尿毒症患者矿物质和骨代谢异常的影响[J].中国继续医学教育,2018(7):75-77.
[11]陈爱群,孙颖,王海涛,毛永辉,刘德平,吴华.血液透析中血压变异性及影响因素的初步探讨[J].中华肾脏病杂志,2013(12):888-892.
[12]王葳,于秀峙,王巍巍,张金元.维持性血液透析患者血压变异性的影响因素分析[J].中国血液净化,2016(11):612-615.
[13]Sands JJ,Usvyat LA,Sullivan T,et al.Intradialytic hypotension:Frequency,sources of variation and correlation with clinical outcome[J].Hemodial.Int,Apr2014,18(2):415-422.
[14]Rocha A,Sousa C,Teles P,et al.Frequency of intradialytic hypotensive episodes:old problem,new insights[J].J.Am.Soc.Hypertens,Oct,2015,9(10):763-768.
[15]Reeves PB,Mc Causland FR.Mechanisms,Clinical Implications,and Treatment of Intradialytic Hypotension[J].Clinical journal of the American Society of Nephrology:CJASN,2018 Feb 26(Epub 2018 Feb 2018
[16]Stefansson BV,Brunelli SM,Cabrera C,et al.Intradialytic Hypotension and Risk of Cardiovascular Disease[J].Clin.J.Am.Soc.Nephrol.Dec,2014,9(12):2124-2132.
[17]何琴,蔡宏,张伟明,et al.维持性血液透析患者贫血状况与预后的关系[J].中华肾脏病杂志,2016(2):110-117.
[18]高丹,白晓莹,娄岩,et al.老年维持性血液透析患者死亡相关因素分析[J].中国老年学杂志,2017(13):3307-3309.
[19]杨晓玮,王荣.血液透析患者的贫血管理[J].中国血液净化,2018(1):13-15.
[20]贾苗,邱宏,谢玉贤.维持性血液透析患者透析前及透析中低血压的危险因素研究[J].临床荟萃,2012(23):2087-2089.
[2]Cook WL,Tomlinson G,Donaldson M,et al.Falls and fall-related injuries in older dialysis patients[J].Clin.J.Am.Soc.Nephrol.Nov,2006,1(6):1197-1204.
[3]Delgado C,Shieh S,Grimes B,et al.Association of Self-Reported Frailty with Falls and Fractures among Patients New to Dialysis[J].Am.J.Nephrol,2015,42(2):134-140.
[4]Bowling CB,Hall R,Khakharia A,et al.Serious fall injury history and adverse health outcomes after initiating hemodialysis among older U.S.adults.The journals of gerontology.Series A,Biological sciences and medical sciences[J].2018 Jan 16(Epub 2018 Jan 2018).
[5]Abedi Yekta AH,Fatollahierad S,Hassabi M,et al.Fall Incidence and Risk Factors in Hemodialysis Patients[J].Turk.Nephrol.Dial.Transplant.J,2016,25(3):263-268.
[6]Rocha,A,Sousa C,Teles P,et al.Frequency of intradialytic hypotensive episodes:old problem,new insights[J].J Am Soc Hypertens,2015,9(10):763-768.
[7]魏丽君,黄惠根,钟杏,等.住院患者跌倒造成损伤的相关因素分析[J].护理研究,2016(4):406-410.
[8]冯志仙,黄丽华,胡斌春.住院患者跌倒造成伤害的风险因素分析[J].中华护理杂志,2013(4):323-327.
[9]袁泉,姚文兵.老年人跌倒的影响因素及预防措施[J].中国老年学杂志,2017(17):4373-4375.
[10]孙丽.透析年限对尿毒症患者矿物质和骨代谢异常的影响[J].中国继续医学教育,2018(7):75-77.
[11]陈爱群,孙颖,王海涛,毛永辉,刘德平,吴华.血液透析中血压变异性及影响因素的初步探讨[J].中华肾脏病杂志,2013(12):888-892.
[12]王葳,于秀峙,王巍巍,张金元.维持性血液透析患者血压变异性的影响因素分析[J].中国血液净化,2016(11):612-615.
[13]Sands JJ,Usvyat LA,Sullivan T,et al.Intradialytic hypotension:Frequency,sources of variation and correlation with clinical outcome[J].Hemodial.Int,Apr2014,18(2):415-422.
[14]Rocha A,Sousa C,Teles P,et al.Frequency of intradialytic hypotensive episodes:old problem,new insights[J].J.Am.Soc.Hypertens,Oct,2015,9(10):763-768.
[15]Reeves PB,Mc Causland FR.Mechanisms,Clinical Implications,and Treatment of Intradialytic Hypotension[J].Clinical journal of the American Society of Nephrology:CJASN,2018 Feb 26(Epub 2018 Feb 2018
[16]Stefansson BV,Brunelli SM,Cabrera C,et al.Intradialytic Hypotension and Risk of Cardiovascular Disease[J].Clin.J.Am.Soc.Nephrol.Dec,2014,9(12):2124-2132.
[17]何琴,蔡宏,张伟明,et al.维持性血液透析患者贫血状况与预后的关系[J].中华肾脏病杂志,2016(2):110-117.
[18]高丹,白晓莹,娄岩,et al.老年维持性血液透析患者死亡相关因素分析[J].中国老年学杂志,2017(13):3307-3309.
[19]杨晓玮,王荣.血液透析患者的贫血管理[J].中国血液净化,2018(1):13-15.
[20]贾苗,邱宏,谢玉贤.维持性血液透析患者透析前及透析中低血压的危险因素研究[J].临床荟萃,2012(23):2087-2089.