心血管疾病住院患者跌倒发生时间规律的调查

目的了解心血管疾病患者发生跌倒的时间规律,为有效防范跌倒提供依据。方法回顾性调查心内科2001年9月至2008年10月心血管疾病患者住院期间发生跌倒的情况。结果31例患者发生跌倒,占0．28％。其中22例（71．0％）发生在11月至次年2月,24例发生在0：00～9;00。结论冬季及0：00～9：00是心血管疾病住院患者易发生跌倒的季节和时段,此季节和时段也是心血管痰病高发期．护士应针对高危季节和时段加强防范。     

医院内住院患者跌倒事件的分析报告

目的调查住院患者跌倒的发生情况和特征。方法回顾性分析2017年1月至6月医院内发生的住院患者跌倒的发生率和特征。结果共有127例患者中发生201次跌倒,其中2例导致骨折。跌倒患者的平均年龄为63.9岁(范围0至91)年。大多数跌倒发生在床边(68.2%)。大约一半的跌倒为滑倒(46.6%),发现跌倒的最常见时间是凌晨2:00～3:59(38/201,18.9%)和6:00～7:59(28/201,13.9%),其次是早晨即患者进行活动时。我院的跌倒率为每千日患者1.37次跌倒。内科的跌倒率最高(3.08次/1000患者-日),其次是急诊科和儿科(每千患者日2.98次/1000患者-日和2.56次/1000患者-日)。结论这项研究展现了普通医院住院患者跌倒的特征,并提示对一些时间段的护理增强或者宣传教育可能有助于减少住院患者跌倒的发生率。     

住院患者跌倒案例的特征分析与启示

目的分析住院患者跌倒特征,为临床护理提供参考。方法对243例住院跌倒患者按跌倒原因和时间点进行归纳分析。结果因下肢肌力减退、平衡受损、头晕眼花、其他因素、活动不慎、精神症状、环境因素导致跌倒例数依次为78、42、36、28、26、17、16例,跌倒高频时间依次为6:00(23例)、7:00(18例)、1:00(17例)、18:00(14例)、23:00(14例)、5:00(13例)、8:00(12例);不同地点发生跌例原因分布差异有统计学意义(P0.01)。结论患者跌倒的原因中下肢肌力减退发生比例最高,其次为平衡功能受损;6:00~7:00及1:00左右是跌倒高发时段。护理人员应针对跌倒主要原因及高发时段,加强评估与防范,降低或避免跌倒发生。     

住院患者跌倒的相关因素分析

目的 了解住院患者跌倒情形和跌倒后的伤害程度,并分析其影响因素.方法 采用回顾性调查研究法,依据跌倒意外事件报告单和不安全事件管理系统对住院患者跌倒事件进行比较分析.结果 287例住院跌倒的患者,以男性、发生在5:00～6:00居多.54.7％跌倒发生在患者房间内,39.3％在如厕／沐浴过程中跌倒,35.9％患者跌倒后发生不同程度的损伤.生活自理能力差、高龄、虚弱、服用抗高血压药物等是跌倒的危险因素.结论 护理人员应针对跌倒的危险因素,制定防护措施,避免住院患者跌倒事件发生,从而提高以患者安全为中心的护理质量.     

医院内住院患者跌倒事件的分析报告

［摘要］ 目的 调查住院患者跌倒的发生情况和特征。方法 回顾性分析2017年1月至6月医院内发生的住院患者跌倒的发生率和特征。结果 共有127例患者中发生201次跌倒，其中2例导致骨折。跌倒患者的平均年龄为63.9岁（范围0至91）年。大多数跌倒发生在床边（68.2%）。大约一半的跌倒为滑倒（46.6%），发现跌倒的最常见时间是凌晨2：00~3：59（38/201，18.9%）和6：00~7：59（28/201，13.9%），其次是早晨即患者进行活动时。我院的跌倒率为每千日患者1.37次跌倒。内科的跌倒率最高（3.08次/1000患者?日），其次是急诊科和儿科（每千患者日2.98次/1000患者?日和2.56次/1000患者?日）。结论 这项研究展现了普通医院住院患者跌倒的特征，并提示对一些时间段的护理增强或者宣传教育可能有助于减少住院患者跌倒的发生率。     

两表一书联用预防内科老年住院患者跌倒

目的 减少老年患者住院期间意外跌倒的发生.方法 自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表(两表一书)于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者:对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档.结果 441例无1例发生跌倒意外.结论 对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷.     

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

目的 了解老年住院患者跌倒伤害事件的发生特征，探索各特征之间的关联性，旨在为制定跌倒伤害预防措施提供参考。方法 回顾性分析上海市3所综合性医疗机构2014年1月至2018年12月发生的115例老年住院患者跌倒伤害事件，采用Aprior算法对跌倒伤害事件发生特征进行关联规则的数据挖掘。结果 通过设定筛选条件共得到473条强关联规则，结合护理专业知识最终得到9条具有临床实际意义的强关联规则，主要包括发生时间为00:01～06:59、3～6种并存疾病和未主动寻求帮助等。结论 老年住院患者跌倒伤害事件的发生有一定的特征，挖掘出的关联规则能够为护理人员提供跌倒伤害高频场景的指导意见，以此识别易导致跌伤的高危人群及环境，为预防跌倒伤害项目提供较好的案例支持。     

质量管理工具在降低住院患者跌倒发生率中的应用

目的 探讨质量管理工具在降低住院患者跌倒发生率中的作用.方法 对57例次跌倒不良事件采用5W1H方法对跌倒事件进行整理,并绘制折线图、柱状图、柏拉图进行统计分析,确定需要解决的问题;用根本原因分析法分析跌倒发生的根本原因;用SWOT法分析跌倒管理中的优劣势、机会和威胁或挑战.采取的改良措施包括修订跌倒管理制度、加强人员培训、采取多种形式宣教、改善环境、完善设施、强化高危时段的防范、实施跌倒质量管理考核等.结果 跌倒发生率由2012～2013年的0.028％降至2014年的0.009％ (P＜0.01).结论 应用恰当适宜的质量管理工具分析护理不良事件发生的原因,实施具体可行的改进措施,可有效降低住院患者跌倒发生率.     

老年髋部骨折患者跌倒的现状研究

目的探讨跌倒所致髋部骨折患者的流行病学情况。方法收集2015年5月至2017年12月住院的年龄≥65岁脆性髋部骨折患者(A组),其中男性179例,女性456例;并以同期老年科住院的年龄≥65岁无髋部骨折病史患者作为对照(B组),其中男性29例,女性52例;应用SPSS 19统计学软件,采用二元Logistic回归分析危险因素。结果①635例髋部骨折老年患者,平均年龄(79.69±7.64)岁;有45.2%的跌倒是发生在家中,在家中的高发地点是卧室、起居室(占家中跌倒的72.1%),跌倒高发时间为入睡时间段,22:00～7:00占33.6%;有54.8%的跌倒是发生在户外,老人因使用非机动车产生的相关非暴力伤占到户外跌倒的28.2%。②发生跌倒后髋部骨折与老人行走时是否使用助行器(P=0.000)、步态(P=0.000)、优势手握力(P=0.000)、内科合并症CCI(P=0.006)有关;其中,行走时需要双手支撑辅助的老年患者比独立行走的老年患者发生髋部骨折的风险高4.7倍(95%CI:2.7,8.0)。③反复发生跌倒,即跌倒超高危老人与行走时是否使用助行器(P=0.000)、优势手握力(P=0.027)、内科合并症指数(P=0.027)相关。结论老年人需尽可能的改善肌力及掌控平衡,居家出门少的老人需要注意卧室和起居室的布置,使用非机动车来助行的老人在上下车时及行驶时需要尽可能的缓慢来预防跌倒。随着人口老龄化程度的加剧,需要更多的社会力量来开展跌倒预防及跌倒损伤发生后的复健工作。     

两表一书联用预防内科老年住院患者跌倒

目的减少老年患者住院期间意外跌倒的发生。方法自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表（两表一书）于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者：对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档。结果441例元1例发生跌倒意外。结论对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷。     

Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients.

BACKGROUND: Lack of nocturnal blood pressure (BP) fall (non-dipping) is common among haemodialysis (HD) patients, but much less is known regarding its association with cardiovascular (CV) disease morbidity and mortality. METHODS: Eighty HD patients initially underwent 24 h ambulatory BP monitoring (ABPM), and then they were defined as either 'dippers' (n=24, nocturnal BP fall > or = 10%) or 'non-dippers' (n=56, fall <10%). Coronary angiography was performed in the patients who had signs and/or symptoms of coronary artery disease (CAD). Twenty-four hour ambulatory ECG was recorded in 20 dippers and 20 non-dipper HD patients, and in 20 normal subjects. All patients were followed for up to 5.8 years (33.0+/-19.1 months). The outcome events studied were the hospitalisations due to CV diseases and CV death. RESULTS: Compared with dippers, non-dippers initially had a higher incidence of coronary artery stenosis (P<0.05) along with left ventricular asynergy (both Ps<0.01). The circadian rhythm of autonomic function was impaired in non-dippers. The incidences of CV events and CV deaths were 3.5 and 9 times higher in non-dippers than in dippers. The cumulative CV event-free survival and CV survival rates were lower in non-dippers than in dippers (P=0.02 and P=0.005, respectively). Based on Cox analysis, non-dipping was associated positively with CV events and CV mortality [hazard ratio (HR) 2.46, 95% CI 1.02-5.92, P=0.038 and HR 9.62, 95% CI 1.23-75.42, P=0.031, respectively]. Meanwhile, nocturnal systolic BP fall, diurnal systolic BP and diurnal pulse pressure were negatively associated with CV event/death. The clinic BP was not associated with CV event/death. CONCLUSIONS: The non-dipping phenomenon is closely related to a high incidence of CV diseases, a poor long-term survival and profound autonomic dysfunction. ABPM is useful in predicting long-term CV prognosis in HD patients.     

“互联网+”远程实时心电监测用于心血管危重症患者院前救护

目的探讨远程实时心电监测管理在心血管危重症患者院前救护中的应用效果。方法将2016年1~12月院前转运至我院心血管内科收住住院的240例危重症患者按转运时间分为两组,每组各120例。对照组院前转运时采用常规心电监护仪监测患者病情变化,观察组院前转运时给予"互联网+"远程实时心电监测病情变化,比较两组院前救护阶段抢救时间和院前抢救成功率。结果观察组患者抢救成功率显著高于对照组,而抢救时间较对照组显著减少(P0.05,P0.01)。结论 "互联网+"远程实时心电监测管理有助于提高心血管危重症患者抢救成功率,缩短抢救时间,节约医疗卫生资源,可常规将"互联网+"远程心电监测管理应用到心血管危重症患者院前救护工作。     

影像学无创评估动脉弹性研究进展

动脉弹性反映血管收缩及舒张功能,是维持整体心血管系统活动的关键因素,并与心血管疾病的发生发展密切相关;早期评估动脉弹性有助于预防和治疗心血管疾病。本文就影像学检查无创评估动脉弹性研究进展进行综述。     

合并心肺疾病老年胃癌患者的围手术期处理

目的 总结合并心肺疾病的老年胃癌患者的围手术期处理方法. 方法 回顾性分析我院于2002年3月～2009年8月期间收治的150例合并心肺疾病的老年胃癌患者的围手术期处理的临床资料,其中合并心血管疾病77例(51.3％),合并呼吸系统疾病43例(28.7％),同时合并这两种疾病者30例(20.0％).TNM分期为:Ⅰ期者3例,Ⅱ期11例,Ⅲ期106例,Ⅳ期30例. 结果 所有患者均顺利完成手术,无术中死亡病例.术后发生并发症共48例(32.0％),其中肺部感染16例,切口液化及感染12例,返流性食管炎10例,胃瘫3例,输出襻不全梗阻2例,吻合口出血1例,十二指肠残端瘘1例,腹腔出血1例,急性胰腺炎1例,急性心肌梗塞1例.围手术期死亡8例,包括心肺功能衰竭6例、DIC 1例、急性心肌梗塞1例. 结论 合并心肺疾病时老年胃癌患者的手术风险较大.针对合并疾病进行正确而合理的围手术期处理,既可降低手术风险,也能减少手术并发症的发生率和围手术期的死亡率.     

西地那非在心血管疾病患者应用的安全性研究进展

西地那非被广泛应用于治疗阴茎勃起功能障碍 (ED),由于许多ED患者同时患有心血管疾病,这类疾病患者应用西地那非治疗的安全性一直是广大医生和患者关注的问题,本文回顾分析西地那非在心血管患者应用的安全性方面的数据资料,就西地那非在心血管疾病患者应用的安全性方面的研究进展进行了综述。     

Prevention and risk assessment of cardiovascular events in a population of patients with psoriasis and psoriatic arthritis

Psoriasis is a chronic, inflammatory, often relapsing disease that is frequently associated with other diseases of similar pathogenesis. The multi-morbidity in the psoriasis population significantly impedes both diagnosis and implementation of appropriate preventive measures. However, the common denominator for this group of diseases is the inflammatory process that initiates the appearance of subsequent symptoms and health consequences, most of which can be avoided or alleviated by modifying the patient’s lifestyle and incorporating appropriate treatment. Health consequences associated with systemic inflammation include cardiovascular incidents and other cardiometabolic diseases.This article was based on available publications on the onset, incidence, and prevention of cardiovascular disease in the psoriasis patient population.     

THE INFLUENCE OF OTHER DISEASES UPON THE OUTCOME OF COLORECTAL CANCER PATIENTS

Little attention may be paid during follow up of colorectal cancer patients to other medical problems because the follow up is normally focused upon the diagnosis of recurrence and the detection of metachronous neoplasms. Attention directed at improving the medical condition of patients would be justified if it were shown that other diseases had a significant effect upon survival. Review of a selected consecutive series of 207 patients included collection of data about variables relating to demography, pathology, presentation, smoking, present and past health, performance, surgery, complications, length of stay, mortality, follow up and cause of death. Significance of relationships between medical and surgical problems and the outcome was determined by analyses of variation. Medical problems were present in 79% of patients; correlated with advancing age. Medical problems were not associated with complications, or with inpatient death. Previous cerebrovascular accident. dementia, limited mobility and increasing numbers of problems were associated with prolonged stay. Prolongation of stay, however, was related mainly to surgical complications. Smoking, which was present in 50% of patients, did not alter performance status, stage or substage, stay or survival significantly. Smoking and respiratory complications were associated significantly. Patients with heart or peripheral vascular disease had significantly poorer survival (P= 0.07) than those without those problems. Survival was reduced significantly for patients known to have diabetes, cardiovascular and cerebrovascular disease and limited mobility. Other malignant neoplasms were responsible for 18% of deaths which were unrelated to colorectal cancer. Residual or recurrent colorectal cancer had a more rapid adverse influence upon outcome than did medical problems. Attention to preventative therapy of cardiovascular disease during follow up might improve survival of patients who have resections for colorectal carcinomata.     

心血管疾病患者记监测日记对血脂水平的影响

目的探讨降低心血管疾病伴高血脂患者血脂水平的有效方法。方法将40岁以上伴高血脂的心血管疾病出院患者83例随机分为两组。对照组(43例)出院后接受常规电话随访及院外健康教育;观察组(40例)在此基础上,使用自制的血脂监测日记记录每日的生活方式及阶段血脂变化。干预1年后比较两组患者的血脂水平。结果干预1年后,观察组总胆固醇、三酰甘油及低密度脂蛋白胆固醇3项指标与对照组比较,差异有统计学意义(均P<0.01)。结论心血管疾病患者记血脂监测日记对控制血脂水平有一定的作用。     

Adenine‐induced chronic kidney disease in rats

Many animal models have been developed to study the causes and treatments of chronic kidney disease (CKD) in humans, an insidious disease resulting from kidney injury and characterized by persistent functional decline for more than 3 months, with or without evidence of structural deficit. The eventual outcome of CKD may be end‐stage kidney disease (ESKD), where patients need dialysis or transplantation to survive. Cardiovascular disease is accelerated in patients with CKD and contributes to increased mortality, with the relationship between CKD and cardiovascular disease being bi‐directional. Most animal models do not mimic the complexity of the human disease as many do not develop CKD‐associated cardiovascular disease. The adenine diet model of CKD in rodents is an exception. The original adenine diet model produced rapid‐onset kidney disease with extensive tubulointerstitial fibrosis, tubular atrophy, crystal formation and marked vessel calcification. Since then, lower adenine intake in rats has been found to induce slowly progressive kidney damage and cardiovascular disease. These chronic adenine diet models allow the characterization of relatively stable kidney and cardiovascular disease, similar to CKD in humans. In addition, interventions for reversal can be tested. Here the key features of the adenine diet model of CKD are noted, along with some limitations of other available models. In summary, the data presented here support the use of chronic low‐dose adenine diet in rats as an easy and effective model for understanding human CKD, especially the links with cardiovascular disease, and developing potential therapeutic interventions.