2023 年第 6 期 第 18 卷

院前跌倒与老年射血分数减低型心力衰竭患者住院期间躯体功能的关系

The relationship between pre-hospital fall and physical function in elderly patients with heart failure with reduced ejection fraction during hospitalization

作者：康云鹏郭雯任爱红陈立颖李江刘文娴

英文作者：Kang Yunpeng Guo Wen Ren Aihong Chen Liying Li Jiang Liu Wenxian

单位：首都医科大学附属北京安贞医院心内重症医学中心，北京100029

英文单位：Cardiac Intensive Care Medical Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：射血分数减低型心力衰竭；跌倒；躯体功能

英文关键词：Heartfailurewithreducedejectionfraction;Fall;Physicalfunction

• 摘要：

• 目的  探讨院前跌倒与老年射血分数减低型心力衰竭（HFrEF）患者住院期间躯体功能的关系。方法  选取2019年1月至2021年12月首都医科大学附属北京安贞医院心内科监护室收治的老年HFrEF患者202例，根据住院前12个月内是否发生过跌倒分为跌倒组（54例）和无跌倒组（148例）。比较2组基线资料和简易躯体功能评估（SPPB）评分，采用Logistic回归方法分析院前跌倒的危险因素，采用受试者工作特征（ROC）曲线分析躯体功能下降与院前跌倒的关系。结果跌倒组年龄高于无跌倒组［（73±7）岁比（69±6）岁］（P＜0.001）。跌倒组男性握力水平低于无跌倒组，平衡测试评分、4 m步行时间评分、椅子站立测试评分及SPPB总分均低于无跌倒组（均P＜0.05）。Logistic回归分析结果显示，年龄与院前跌倒发生密切相关（比值比=1.078，95%置信区间：1.015～1.145，P=0.015）。SPPB分值对HFrEF患者发生院前跌倒预测的曲线下面积为0.624，以SPPB评分7.5分为界值，预测老年HFrEF患者院前跌倒的敏感度为61.5%，特异度为62.0%。结论  出现院前跌倒的老年HFrEF患者会伴随有躯体能力下降，但躯体能力下降并非跌倒发生的独立危险因素。

• Objective    To explore the relationship between pre-hospital fall and physical function in elderly patients with heart failure with reduced ejection fraction (HFrEF) during hospitalization. Methods  From January 2019 to December 2021, 202 elderly patients with HFrEF admitted to the Department of Cardiology Intensive Care Unit, Beijing Anzhen Hospital, Capital Medical University were selected, and they were divided into fall group (54 cases) and non-fall group (148 cases) according to whether falls occurred within the first 12 months of hospitalization. The baseline data and the Simple Physical Performance Battery (SPPB) scores in the two groups were compared, Logistic regression method was used to analyze the risk factors of pre-hospital fall, and the receiver operating characteristic (ROC) curve was used to analyze the relationship between the decline of physical function and pre-hospital fall. Results  The age in the fall group was higher than that in the non-fall group ［(73±7)years vs (69±6)years］ (P＜0.001). The grip strength level of men in the fall group was lower than that in the non-fall group, and the balance test score, 4 m walking time score, chair standing test score and total SPPB score were lower than those in the non-fall group (all P＜0.05). Logistic regression analysis showed that age was closely related to the incidence of pre-hospital fall (odds ratio=1.078, 95% confidence interval: 1.015-1.145, P=0.015). The area under the curve of SPPB score for predicting the pre-hospital fall in patients with HFrEF was 0.624. Taking SPPB score of 7.5 as the cut-off value, the sensitivity and specificity of predicting pre-hospital fall in elderly patients with HFrEF were 61.5% and 62.0% respectively. Conclusions  Pre-hospital fall in elderly patients with HFrEF will be accompanied by a decline in physical ability, but the decline in physical ability is not an independent risk factor for falls.