平衡及肌力运动操降低老年患者跌倒

目的探讨平衡及肌力运动操降低老年患者跌倒的效果。方法将80例具有一定行走能力的老年患者随机分为对照组和观察组各40例。对照组采用常规预防跌倒的措施并强调加强散步等体育锻炼;观察组在此基础上,进行平衡及肌力运动操训练。结果训练8周后观察组Berg平衡量表评分及Motricity指数中下肢肌力积分显著高于对照组（均P〈0.01）;观察组住院期间跌倒发生率低于对照组。结论平衡及肌力运动操能提高老年患者的平衡能力及肌力,从而降低老年患者的跌倒风险。     

Teach-back结合专科视频教育用于老年患者平衡功能训练

目的探讨Teach-back结合专科视频教育在老年患者平衡功能训练中的应用效果。方法将100例老年患者按入院时间分为对照组和观察组各50例。对照组实施常规健康教育、平衡功能训练和出院后回访,观察组将Teach-back结合专科视频教育用于平衡功能训练中。比较两组出院后3个月平衡功能训练掌握程度、依从性及Breg平衡量表得分、跌倒发生率。结果出院后3个月观察组平衡功能训练掌握程度、依从性、Breg平衡量表得分显著高于对照组(均P 0. 01);观察组出院后3个月内跌倒发生率低于对照组。结论 Teach-back结合专科视频教育可以有效提高老年患者平衡功能训练掌握程度和依从性,从而提高平衡能力,降低跌倒风险。     

平衡功能训练对康复期脑卒中患者预防跌倒的作用

目的探讨平衡功能训练对康复期脑卒中患者跌倒预防的作用。方法将108例康复期脑卒中患者采用随机数字表法分为观察组与对照组各54例,对照组按常规进行康复训练,观察组在常规康复训练基础上实施静态坐位及站立的平衡功能训练。比较出院后3个月两组跌倒和Berg平衡量表得分情况。结果观察组跌倒发生率显著低于对照组,Berg平衡量表得分显著高于对照组(P0.05,P0.01)。结论对康复期脑卒中患者早期开展并长期坚持平衡功能训练,能有效提高患者身体平衡能力,降低跌倒的发生。     

核心稳定训练对预防老年骨质疏松症患者跌倒的影响

目的观察核心稳定训练对预防老年骨质疏松症患者跌倒的影响。方法选择2015年7月至2016年6月份在我们病区住院,诊断为老年骨质疏松症的患者120例(Morse跌倒评估为高危风险),随机分为对照组和实验组各60例。对照组:遵医嘱指导病人常规抗骨质疏松治疗,实施常规预防跌倒的干预护理;实验组:在对照组的基础上增加核心稳定训练。实施1年后,考察两组病人的疼痛评估、步态分析结果、下肢肌力测定、跌倒发生率等指标的治疗前后差异和组间差异。结果实验组与对照组在干预后各项考察指标均有改善;其中,对照组治疗前后改善轻微,实验组治疗前后改善显著,明显优于前者;且实验组的再次跌倒发生率及跌倒损伤程度两项指标下降明显。结论核心稳定训练能有效缓解OP患者腰部疼痛,提高骨质疏松症患者平衡功能和下肢肌力,因此该训练是一项预防跌倒的有效措施,有望成为老年骨质疏松患者的护理路径的一个重要组成部分。     

老年人跌倒相关因素及三种防跌倒干预措施的效果分析

目的探讨三种干预模式对预防老年人跌倒效果的差异。方法收集2015年6月至2018年1月我院骨科中心收治的568例老年骨科患者为研究对象,根据有无跌倒史分为跌倒组175例和非跌倒组393例,统计分析可能导致患者跌倒的危险因素。在除部分存在明显异质性的病例,将纳入的128例跌倒组患者随机分为振动训练组(VT组)、平衡板训练组(BBT组)、单纯跌倒知识宣教组(KE组)和对照组各32例,对比分析3种干预措施的差异。对比分析3种干预措施的差异,如运动功能、肌肉力量、平衡力者、步行功能、日常生活等相关指标。结果以干预完成时间为截点,对照组出现1例新发跌倒,其余干预组均未出现跌倒病例。以干预完成后3个月为截点,对照组、VT组、BBT组、KE组分别出现2例、1例、2例、1例新发跌倒,四组新发跌倒率比较差异无统计学意义(P0.05)。干预后,对照组和KE组患者运动功能、肌肉力量、平衡力均无明显变化(P0.05);BBT组患者运动功能、肌力、平衡力均有明显改善,但握力无明显改变;VT组患者运动功能、平衡力恢复良好,但肌肉力量无改善;对照组和KE组患者步行能力、日常生活相关评分均无明显变化(P0.05);VT组和BBT组患者的步行能力及日常生活能力评分均有明显改善(P0.05),但工具性日常生活能力无明显变化(P0.05)。结论定期的振动训练和平衡板训练对存在跌倒高危因素骨科患者的运动能力及生活质量有明显改善作用,且全身振动训练效果更佳,单纯健康教育无明显意义。     

基于PASS理论的方步运动方案在卒中后认知障碍患者中的应用

目的 观察基于PASS理论构建的方步运动方案对卒中后认知障碍患者认知功能、平衡功能、跌倒风险的影响。方法 将卒中后认知障碍患者随机分为观察组41例，对照组39例。对照组实施常规专科护理、康复训练和认知训练，观察组在对照组基础上采取基于PASS理论构建的方步运动方案干预，比较两组干预效果。结果 干预1个月、3个月、6个月后，观察组蒙特利尔认知评估量表评分、Berg平衡量表评分显著高于对照组，Morse跌倒评估量表评分显著低于对照组(均P<0.05)。结论 基于PASS理论构建的方步运动方案能够改善卒中后认知障碍患者的认知功能、平衡能力，降低患者跌倒风险。     

术侧肌力训练对老年全膝关节置换术患者下肢功能的影响

目的:观察下肢髋膝踝关节肌力训练对全膝关节置换术后老年患者术侧下肢功能的影响.方法:将141例全膝关节置换术后老年患者分为观察组71例和对照组70例.对照组给予常规康复练习和负重训练,观察组在对照组的基础上给予术侧下肢髋膝踝关节肌力训练.2组疗程均为3个月.观察2组患者训练前后平衡功能[采用Berg平衡量表(BBS)评...     

护养中心老年人防跌倒保健操训练的效果

目的探讨防跌倒保健操对增强老年人身体柔韧性和平衡能力的作用。方法以重庆市某老年护养中心自理区招募的100名志愿老年人作为研究对象,随机分为干预组和对照组各50名。干预组进行为期1年的防跌倒保健操训练,对照组自愿参加护养中心组织的活动。结果干预组46名、对照组48名完成全程研究。两组功能伸展测试、坐位体前屈测试及平衡功能测试各项指标存在显著的组间效应;跌倒发生率干预组显著低于对照组(均P0.05)。结论应用防跌倒保健操长期训练,能提高老年人下肢肌力、身体的平衡功能和柔韧性,从而预防跌倒的发生。     

弹力围巾操训练对老年2型糖尿病患者血糖水平、双下肢肌力及骨骼肌质量的影响

目的探讨弹力围巾操训练对老年2型糖尿病(type 2 diabetes mellitus, T2DM)患者血糖水平、双下肢肌力及骨骼肌质量的影响。方法选取河南省人民医院郑州大学人民医院2021年2月至2022年11月期间收治的104例老年T2DM患者作为研究对象, 依照干预方式分为对照组和干预组。对照组52例给予常规糖尿病治疗和健康宣教, 帮助患者维持日常运动和生活状态, 干预组52例给予常规护理联合弹力围巾操训练。对比干预前、后两组患者血糖水平、双下肢肌力、骨骼肌质量。结果干预12周后两组患者糖化血红蛋白、空腹血糖、餐后2 h血糖水平较干预前降低, 干预组低于对照组(P<0.05)。两组患者干预前至干预12周峰力矩值水平呈逐渐升高趋势, 干预组干预8、12周后峰力矩值水平高于对照组(P<0.05)。两组患者干预前至干预12周后双下肢骨骼肌质量水平呈逐渐升高趋势, 干预组干预8、12周后双下肢骨骼肌质量水平高于对照组(P<0.05)。结论弹力围巾操训练有助于老年T2DM患者血糖水平控制, 改善其双下肢肌力, 改善骨骼肌质量。     

脑卒中肢体功能障碍患者跌倒预防的核心稳定性康复训练

目的探讨脑卒中肢体功能障碍患者实施核心稳定性训练预防跌倒的方法及效果。方法将100例脑卒中患者按照入院时间顺序分成干预组和对照组各50例,对照组按照Morse跌倒风险评估结果,对高风险患者实施常规跌倒预防措施;干预组在此基础上加强功能康复训练的益处和跌倒预防的强化教育,并配合核心稳定性训练。结果干预4周后,干预组跌倒发生例数减少;患者肢体运动功能及日常生活活动能力得分显著优于本组干预前和对照组(均P0.01)。结论强化认知教育配合核心稳定性训练可提高脑卒中患者肢体功能及日常生活活动能力,从而降低跌倒发生风险。     

Integrating Pilates Exercise into an Exercise Program for 65+ Year-Old Women to Reduce Falls

The purpose of this study was to determine if Pilates exercise could improve dynamic balance, flexibility, reaction time and muscle strength in order to reduce the number of falls among older women. 60 female volunteers over the age of 65 from a residential home in Ankara participated in this study. Participants joined a 12-week series of 1-hour Pilates sessions three times per week. Dynamic balance, flexibility, reaction time and muscle strength were measured before and after the program. The number of falls before and during the 12-week period was also recorded. Dynamic balance, flexibility, reaction time and muscle strength improved (p < 0. 05) in the exercise group when compared to the non-exercise group. In conclusion, Pilates exercises are effective in improving dynamic balance, flexibility, reaction time, and muscle strength as well as decreasing the propensity to fall in older women.

Key points

• Pilates-based exercises improve dynamic balance, reaction time and muscle strength in the elderly.
• Pilates exercise may reduce the number of falls in elderly women by increasing these fitness parameters.

Key words: Pilates, elderly women, balance, reaction time, muscle strength     

Balance, aging, and osteoporosis: effects of cognitive exercises combined with physiotherapy

OBJECTIVE: To evaluate whether performing cognitive tasks while exercising influenced the effects of an exercise program designed to reduce the risk of falling in elderly women with osteoporosis. METHODS: We included 68 osteoporotic women older than 70 years of age (mean age, 73.5 years+/-1.6) who followed a program of 12 sessions of balance, coordination, and ambulation exercises designed to lessen the risk of falling. The patients were divided into two groups based on proximity to the study centers. The groups were randomly allocated to the exercise program alone (N=31, single-task group) or to the same program combined with cognitive tasks performed while exercising (N=37, dual-task group). Timed up-and-go tests and one-leg balance (OLB) tests were done at baseline, at the end of the exercise program, and 3 months after the end of the exercise program. RESULTS: In both groups, the exercise program produced significant improvements in up-and-go and OLB times. Additional improvements occurred over the first 3 months following the program. Adding cognitive exercises did not provide added efficacy. CONCLUSIONS: Balance was improved after the exercise sessions. The improvements were clinically significant and increased over time.     

奥塔戈运动项目对老年脑卒中患者跌倒的影响

目的探讨奥塔戈运动项目对老年脑卒中患者跌倒的预防作用。方法将上海市某三级甲等综合性医院出院的56例老年脑卒中患者随机分为干预组（28例）和对照组（28例）。出院后两组均由研究者定期电话随访,对照组保持原有的日常生活活动,干预组接受16周的奥塔戈运动。结果干预16周后,干预组行奥塔戈运动依从率为76．92％;两组跌倒发生次数和移动能力比较,差异无统计学意义（均P〉0．05）;干预组平衡力得分高于干预前水平和对照组同期水平（均P〈0．05）。结论奥塔戈运动项目可以提高老年脑卒中患者的平衡力水平,对改善患者躯体功能有一定效果;该运动项目对是否可以预防老年脑卒中患者跌倒还有待于进一步研究。     

Recovery of postural stability following conscious sedation with midazolam in the elderly

Purpose. To investigate the differences in recovery of postural stability, after obtaining similar intravenous sedation levels with midazolam, in elderly and younger patients undergoing dental surgery. Methods. We studied 15 elderly patients (>65 years) and 15 younger patients (<55 years) after intravenous sedation. Midazolam was carefully titrated over 4–5 min until slow response to verbal commands, ptosis of the eyelid, or slight slurring of speech was obtained. Parameters were postural balance tests and an addition test, as a psychomotor function test. Results. The dose of midazolam in the elderly group (0.045 ± 0.012 mg·kg⁻¹) was 62% of that in the younger group (0.074 ± 0.026 mg·kg⁻¹). In evaluation of the percentile rank of a balance test with a visual feedback system, which contained a dynamic balance element, recovery at 60 min in the elderly group was significantly slower than that in the younger group. However, the recovery times for the balance test and the addition test, at which the significantly changed values were restored to the baseline values, were 120 min and 90 min, respectively, in both groups. Conclusion. In the recovery from sedation, elderly patients had more difficulty in acquiring postural adjustment during movement than in maintaining a standing posture. If the dose is carefully administered, however, even elderly patients might be able to return home 2 h after midazolam administration, as could the younger patients. Received: November 6, 2001 / Accepted: April 22, 2002     

认知行为干预在老年髋部骨折病人跌倒恐惧中的应用效果

目的探讨认知行为干预方法在老年髋部骨折病人跌倒恐惧中的应用效果。方法选取2019年6月至2020年1月在我院骨科收治的90例有跌倒恐惧的老年髋部骨折病人为研究对象,采用随机数字表法分为观察组与对照组,每组各45例。对照组采用常规护理,观察组在实施基础护理的基础上采用认知行为干预。术前1 d、出院当天、干预1个月和3个月时,采用活动平衡信心量表(ABC)、Berg平衡量表(BBS)、改良Barthel指数评定量表(MBI),观察评估病人跌倒风险程度、平衡功能和日常生活活动能力。结果出院当天、干预1个月和干预3个月时,观察组的活动平衡信心及平衡能力方面均明显优于对照组,差异均有统计学意义(P均<0.05)。干预1个月和3个月时,观察组的日常生活活动能力均明显优于对照组,差异有统计学意义(P均<0.05)。结论在降低老年髋部骨折病人的跌倒恐惧、提高生活质量方面,认知行为干预方法具有良好的效果,可在临床上推广应用。     

老年重症开胸手术围术期呼吸循环变化与呼吸并发症的相关性

目的 探讨老年病人术后呼吸并发症的发生原因及预防策略.方法 对58例高龄或重要脏器有合并症,及行大手术的老年重症开胸手术病人（组1）进行围术期呼吸、循环监测,记录脱氧动脉血气、出入液量、尿比重、漂浮导管血流动力学指标,并与56例非老年病人（组2）进行比较.结果 全组12例呼吸并发症均见于老年重症病人（组1A）,10例为术后早期低氧血症,均始发于术后第2、3 d,另2例为后期感染引起Ⅱ型呼吸衰竭（呼衰）.多因素回归分析示术前呼吸道合并症和肥胖是老年病人术后发生呼吸并发症的独立预测因素.组1A术后前3 d PaO2显著低于未发生呼吸异常的老年病人（组1B）及组2,组1A与组1B术后PaCO2变化相似均显著低于组2.三组间术后第1 d液体出入平衡差异显著,组2为负平衡（-243ml）,组1B为轻度正平衡（＋109ml）,而组1A则为显著的正平衡（＋832ml）,术后前3 d尿比重均显著高于组2.漂浮导管监测发现老年病人术后前3 d心排量上升、外周血管阻力降低表现为循环高动力状态,而肺血管阻力则明显高于术前.结论 老年病人术前呼吸道合并症多见,其是术后易发生呼吸并发症的主要危险因素,呼吸异常是老年重症病人开胸手术后最主要的并发症和死亡原因,手术创伤引起的细胞外液增加所致＂相对性肺水肿＂是造成术后早期容易出现呼吸失代偿的内在因素.减轻创伤应激和严格输液管理可能有助于预防呼吸并发症的发生,密切监护老年病人的呼吸循环指标、尤其是脱氧动脉血气分析以及尿量、尿比重变化趋势,有助于及早发现呼吸异常并及时介入处理以避免发展成为呼吸衰竭.     

首诊责任护士家庭跟进照料对老年卧床患者出院指导依从性的影响

目的 探讨首诊责任护士家庭跟进照料模式对老年卧床患者出院指导依从性及护理满意度的影响.方法 将出院后回归家庭的120例老年卧床患者分为对照组与观察组各60例.对照组为轮班制责任护士按常规登记资料及评估患者情况,访视及实施护理干预措施;观察组则为首诊责任护士从入院首次接诊到患者回归家庭全程负责该患者的访视及护理干预.比较两组患者对出院指导依从性及护理满意度.结果 观察组在系统治疗、康复锻炼、并发症预防、生活方式、按时复诊方面依从性显著高于对照组（P＜0.05,P＜0.01）,护理满意度显著高于对照组（P＜0.01）.结论 采用首诊责任护士家庭跟进照料模式可密切护患关系,提高患者对出院指导的依从性和护理满意度,改善老年卧床患者健康预后.     

Jumping exercises with and without raloxifene treatment in healthy elderly women

Several meta-analyses confirm that physical exercise can slow down postmenopausal bone loss, but it is not clear whether physical exercise alone can increase bone mass. Our intent was to evaluate high-impact exercises (including jumping) and combined balance and leg-strength training, with and without raloxifene treatment, in three healthy elderly women, age 68-71 years. The 40-week study period consisted of two 17-week exercise periods with a 6-week rest period in between. The jumping exercises were performed both vertically and in different directions. Effects were measured in bone mineral density (BMD), balance, maximal gait speed, and leg extensor strength. BMD (g/cm(2)) was measured with dual-energy X-ray photon absorptiometry (DXA) at the proximal femur, lumbar spine, and total body. After the first exercise period, large losses of trochanteric BMD (8.1%-10.8%) were seen in all subjects. After both 6 weeks of rest and the second exercise period, which included both exercise and raloxifene, BMD increased in all subjects. During both exercise periods, the balance, gait speed, and leg extensor strength increased in all subjects. The results show that this kind of high-impact exercise had limited effects on BMD, but had large positive effects on balance, gait speed, and leg extensor strength. In conclusion, high-impact exercise in elderly women improves their fall risk factors, but, at least without raloxifene treatment, the trochanteric fracture risk might even increase because of reduction in the regional bone mass.     

脊柱外伤床上体疗操的设计与应用研究

目的探讨脊柱外伤患者卧床治疗期间床上功能锻炼体疗操的临床效果,使患者达到运动康复治疗的目的。方法将120例胸椎、腰椎外伤患者(截瘫患者除外)按住院时间顺序分为对照组和观察组各60例。对照组采用常规功能锻炼的指导方法;观察组通过体疗操进行功能锻炼,体疗操共8节,通过文献回顾法、专家咨询法、临床试验择优法自行编制,并制作成视频文件。评估两组患者住院3周后功能锻炼掌握情况、并发症发生率及功能锻炼的依从性。结果观察组患者功能锻炼的掌握情况、功能锻炼的依从性显著优于对照组(均P<0.01),便秘发生率显著低于对照组(P<0.01)。结论体疗操有助于脊柱外伤患者系统有效地进行康复锻炼,达到康复治疗的目的,减少并发症的发生。     

Preventative effect of exercise against falls in the elderly: a randomized controlled trial

Summary  The present study was conducted to determine the effect of 5-month exercise program on the prevention of falls in the elderly. The exercise training, which consisted of calisthenics, body balance training, muscle power training, and walking ability training 3 days/week improved the indices of the flexibility, body balance, muscle power, and walking ability and reduced the incidence of falls compared with non-exercise controls. The present study showed the beneficial effect of the exercise program aimed at improving flexibility, body balance, muscle power, and walking ability in preventing falls in the elderly. Introduction  The present study was conducted to determine the effect of exercise on the prevention of falls in the elderly. Methods  Sixty-eight elderly ambulatory volunteers were randomly divided into two groups: the exercise and control groups. The daily exercise, which consisted of calisthenics, body balance training (tandem standing, tandem gait, and unipedal standing), muscle power training (chair-rising training), and walking ability training (stepping), were performed 3 days/week only in the exercise group. No exercise was performed in the control group. Results  After the 5-month exercise program, the indices of the flexibility, body balance, muscle power, and walking ability significantly improved in the exercise group compared with the control group. The incidence of falls was significantly lower in the exercise group than in the control group (0.0% vs. 12.1%, P = 0.0363). The exercise program was safe and well tolerated in the elderly. Conclusions  The present study showed the beneficial effect of the exercise program aimed at improving flexibility, body balance, muscle power, and walking ability in preventing falls in the elderly.