集束化技能護(hù)理在阿爾茨海默病患者防跌倒中的應(yīng)用研究*

□ 徐素娟 XU Su-juan 姜楊 JIANG Yang* 夏燕南 XIA Yan-nan

Objective To explore the effect of bundled care combined with skill training on preventing falls in patients with Alzheimer's disease. Methods A total of 711 elderly patients with Alzheimer's disease hospitalized from January to December 2016 were included as the control group, and 993 elderly patients with Alzheimer's disease hospitalized from January to December 2017 were included as the observation group. The control group was given routine care. On the basis of routine care, bundled care combined with team skill training was adopted the observation group. The incidence of falls and severity of injuries were compared for the two groups. Results The incidence of falls was 0.50% (5/993), and 1.41% (10/711) in the observation group and in the control group, respectively, and the difference was statistically significant (p＜0.05). Among the 5 patients falling from bed in the observation group,there were 2 patients with mild injuries and 3 without injury. Among the 10 patients falling from bed in the control group, there were 5 patients with severe injuries, 3 moderate injuries, 1 mild injury and 1 without injury. The falls of the observation group was relatively less severe compared with the control group. Conclusion The combination of bundled care and team skill training can effectively reduce the incidence of falls, ensure patient safety, improve patients' quality of life, and improve the quality of care in hospitalized patients with Alzheimer's disease.

跌倒是世界性的公共衛(wèi)生問題，我國傷害死亡原因的第4位，而在65歲以上的老年人中則為首位傷害死亡原因，也是非致命損傷和因傷住院的最常見原因[1]。據(jù)文獻(xiàn)報道，我國老年人跌倒發(fā)生率為14%～34%[2]。研究顯示在阿爾茨海默病病房跌倒發(fā)生率為13.125次每1000張床位[3]。雖然現(xiàn)階段我國臨床醫(yī)學(xué)針對阿爾茨海默病患者制定了很多防跌倒護(hù)理措施，但是效果并不顯著[4]。集束化護(hù)理是基于循證、內(nèi)在關(guān)聯(lián)的護(hù)理方法組合建立的一組護(hù)理方案[5]。團(tuán)隊技能訓(xùn)練是以日本生活技能訓(xùn)練理論為基礎(chǔ)，與放松療法(太極十二拍)相結(jié)合的團(tuán)隊訓(xùn)練方式，由精神科臨床醫(yī)生、護(hù)士、心理治療師等相關(guān)人員參與，對精神障礙患者進(jìn)行生活技能改善的康復(fù)訓(xùn)練模式[6]。2017年本院運(yùn)用集束化護(hù)理與團(tuán)隊技能訓(xùn)練模式相結(jié)合的方式，對阿爾茨海默病住院患者進(jìn)行防跌倒干預(yù)，取得了較滿意的效果，報告如下。

對象與方法

1.研究對象。選取本院2016年1月至2016年12月收治的阿爾茨海默病住院患者711例，作為對照組，其中男365例，女346例，年齡為81.36±7.21歲。2017年1月至2017年12月收治的阿爾茨海默病住院患者993例，作為觀察組，其中男512例，女481例，年齡為83.11±6.32歲。兩組一般資料比較，差異無統(tǒng)計學(xué)差異p＞0.05。納入標(biāo)準(zhǔn)：(1)兩組患者均符合DSM-Ⅳ擬定的阿爾茨海默病臨床診斷標(biāo)準(zhǔn)。(2)“跌倒墜床危險因子”評分≥4分。(3)每個患者均配有陪護(hù)。排除標(biāo)準(zhǔn)：患者心肺疾病嚴(yán)重，中途出院、轉(zhuǎn)科或死亡。患者本人和(或)家屬簽署知情同意書。……