帕金森病患者居家环境对居家跌倒发生的影响研究

doi:10.16138/j.1673-6087.2023.06.006

摘要/Abstract

摘要：

目的：调查帕金森病（Parkinson disease，PD）患者的居家跌倒情况，以及居家环境因素对居家跌倒发生的影响。方法：采用便利抽样法，纳入2020年5月—2022年9月期间于我院功能神经外科就诊的260例PD患者，根据患者在调查前近3个月内有无跌倒史，将其分为跌倒组和未跌倒组。采用一般资料以及居家跌倒情况调查表、运动障碍协会（Movement Disorder Society，MDS）PD统一评定量表Ⅲ（MDS unified-PD rating scale Ⅲ, MDS UPDRS-Ⅲ）、左旋多巴日等效剂量（levodopa equivalent daily dose, LEDD）和居家跌倒风险筛查（home falls and accidents screening tool，HOME FAST）量表进行问卷调查。结果：57例（22.5%）患者调查前近3个月内发生过跌倒，其中19例（33.3%）多次跌倒，49例（86.0%）在室内跌倒，51例（89.5%）主要发生在白天，49例（86.0%）跌倒时为单独一人。居家环境因素中，地板（84.5%）和卫生间（63.2%）没有防滑垫为最常见的问题。跌倒组PD患者居家跌倒风险评估总分低于未跌倒组[（19.84±3.72）分比（21.27±2.72）分，t=3.190，P=0.002]。多因素Logistic回归分析显示，通道有杂乱物品 [优势比（odds ratio, OR）=1.214，P=0.003]以及楼梯旁没有扶手（OR=1.333，P=0.028）是PD患者居家跌倒的主要环境危险因素。结论：PD患者居家跌倒发生率高，居家环境对于PD居家跌倒的发生有影响，通道有杂物以及楼梯旁没有扶手是PD患者跌倒的主要危险因素。

关键词: 帕金森病, 运动障碍, 居家跌倒, 居家环境

Abstract:

Objective To investigate the influence of home environment on the incidence of home falls in patients with Parkinson disease (PD). Methods Using a convenience sampling method, 260 patients with PD treated in the functional neurosurgery department of our hospital from May in 2020 to September in 2022 were enrolled as study projects. The patients were divided into non-home fall group and home fall group based on whether they had fallen in the past three months. A questionnaire survey including general information and home falls questionnaire, Movement Disorder Society (MDS) unified PD disease rating scale Ⅲ (UPDRS-Ⅲ), levodopa equivalent daily dose (LEDD) and home falls and accidents screening tool (HOME FAST) was conducted, and the collected data was analyzed. Results There were 57 (22.5%) patients had fallen in the previous three months, 19 (33.3%) patients fell several times, 49 (86.0%) patients fell indoors, 51 (89.5%) patients fell mainly during the daytime, and 49(86.0%) patients fell without accompany. In the home environment, floor (84.5%) and toilet (63.2%) without anti-slip pads were the most common reason to lead to fall. The total score of HOME FAST in the home fall group was lower than that in the non-home fall group [(19.84±3.72) vs (21.27±2.72), t=3.190, P=0.002]. Multivariate Logistic regression analysis showed that sundry objects in the passageway[odds ratio (OR)=1.214, P=0.003] and the lack of handrails beside the stairs (OR=1.333, P=0.028) were the major risk factors of home falls. Conclusions There is high incidence of home falls in PD patient, and the home environment have an impact on the occurrence of home falls. Sundry objects in the passageway and the lack of handrails beside the stairs are the major risk factors of home falls in patients with PD.

Key words: Parkinson disease, Movement disorder, Home falls, Home environment

中图分类号:

R742

龚磊, 王珏, 曾志童, 李殿友, 孙伯民, 查庆华, 邱娴. 帕金森病患者居家环境对居家跌倒发生的影响研究[J]. 内科理论与实践, 2023, 18(06): 404-409.

GONG Lei, WANG Jue, ZENG Zhitong, LI Dianyou, SUN Bomin, ZHA Qinghua, QIU Xian. Influence of home environment on incidence of home falls in patients with Parkinson’s disease[J]. Journal of Internal Medicine Concepts & Practice, 2023, 18(06): 404-409.

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项目	未跌倒组 (n=196)	跌倒组 (n=57)	t/χ²	P
性别[n(%)]			0.245	0.653
男	107（54.6）	29（50.9）
女	89（45.4）	28（49.1）
年龄（岁）	63.21±10.55	62.85±8.09	0.231	0.817
病程（年）	9.21±4.14	11.02±5.63	-2.651	0.009
UPDRS-Ⅲ评分(分)	54.13±13.87	60.56±12.38	-3.322	0.001
步态（3.10^*）	1.92±0.69	2.29±0.86	-3.505	0.001
冻结步态（3.11）	0.65±1.16	1.57±1.79	-4.656	<0.001
平衡（3.12）	2.22±1.00	2.78±1.04	-3.801	<0.001
LEDD（分）	386.53±192.28	431.14±198.89	-1.598	0.127
服用助眠药物[n(%)]	36（18.4）	11（19.3）	0.186	0.693
服用降压药物[n(%)]	43（21.9）	8（14.0）	1.714	0.260

分数	未跌倒组（n=196）	跌倒组（n=57）	t	P
总分	21.27±2.72	19.84±3.72	3.190	0.002
居家环境总分	11.59±1.39	11.28±1.62	1.401	0.016
躯体功能总分	9.68±2.33	8.56±3.14	2.930	0.004

项目	未跌倒组 (n=196)	跌倒组 (n=57)	χ²	P
居家环境因素
通道没有杂乱物品	184（93.9）	45（78.9）	11.464	0.001
床上开关灯方便	196（100.0）	54（94.7）	10.440	0.001
室内的楼梯旁都有可用的扶手	179（91.3）	46（80.7）	5.065	0.024
躯体功能因素
进出厕所方便安全	185（94.4）	47（82.5）	8.259	0.004
能方便安全地将饭菜从厨房拿到餐桌上	156（79.6）	35（61.4）	7.896	0.005
能方便安全地上下室内外的楼梯	160（81.6）	34（59.6）	11.934	0.001
能方便安全地使用入口的门	187（95.4）	49（86.0）	6.283	0.012

项目	偏回归系数	标准误	Wald χ²	自由度	OR	P
通道有杂乱物品	1.594	0.508	8.858	1	1.214	0.003
楼梯旁没有扶手	1.871	0.639	4.846	1	1.333	0.028
床上开关灯不方便	1.001	0.657	2.318	1	2.720	0.128
进出厕所不方便安全	0.647	0.822	0.620	1	1.910	0.431
不能方便安全地将饭菜从厨房拿到餐桌上	-0.140	0.566	0.061	1	0.869	0.804
不能方便安全地上下室内外的楼梯	-0.603	0.552	1.194	1	0.547	0.275
不能方便安全地使用入口的门	-0.937	0.858	1.194	1	0.392	0.274
病程	0.061	0.044	1.869	1	1.062	0.172
UPDRS-Ⅲ评分	0.025	0.014	3.047	1	1.025	0.081
LEDD	0.263	0.193	1.863	1	1.301	0.172