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Abstract: With the aging of population structure, the age-related balance dysfunction increases gradually, and the injuries related fall are increasing, which cause a serious social and economic burden. In addition, dizziness or vertigo is very common clinically, and these patients also have a higher risk of falling. In order to reduce the incidence of falls, targeted prevention measures are urgently needed. In this paper, the risk assessment, preventive measures and rehabilitation strategies of falls are systematically expounded, it is hoped that it will be helpful for the prevention and treatment of falls.
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Key words:
- falls /
- dizziness /
- vertigo /
- vestibular rehabilitation
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表 1 跌倒风险病史问卷
病史或相关因素 内容 1跌倒病史 以前是否有跌倒的病史 跌倒发生的详细情况：跌倒次数及时间(最近一次跌倒的时间)，怎么跌倒的，是否有损伤，等。 2药物史 是否使用≥4种药物(老年人大多同时使用多种药物，≥4跌倒风险加剧) 某些药物可能具有高跌倒风险。在过去两周内是否使用新药物，是否使用以下类别的药物：镇静剂、安眠药、抗抑郁药、抗高血压药、抗糖尿病类药物，是否使用抗焦虑或镇静剂等有较高跌倒风险的药物。 3主要疾病史 某些具有高跌倒风险的疾病：运动性疾病、帕金森、骨关节疾病。 主要系统性病史：心血管疾病(包括心律不齐、动脉硬化性心脏病等)，糖尿病(以及糖尿病引起的多发性周围神经病造成下肢深感觉减退)，脑血管疾病(包括卒中、跌倒发作)，体位性低血压(疾病或药物引发的)。脑白质病也是防跌倒门诊最常见的疾病之一。 4主要症状史 特别容易引起跌倒的一些主要症状，例如：是否有眩晕、步态障碍、意识丧失，肌肉有无力量，是否有眼疾、视力受损等情况。 5环境因素 一些特定环境因素，如：照明条件差、地板上太蓬松的地毯、不稳固的家具、楼梯或台阶的扶手太差、厕所或床太低等情况有增加跌倒的风险。 
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表 2 跌倒风险系统评估
内容 评估指标 1认知功能障碍 简易智力状态检查量表可筛查和评估认知功能状态，其敏感度达87%，特异性为82%。从11个方面评估认知功能状态：30表示正常，≤23为异常。 2反应时间延长 对事件的反应时间延长导致反应迟钝，最常用的评估方法是简单反应时间。 3精神疾患 常见的精神疾患为抑郁症和恐惧症。评估量表主要是医院焦虑抑郁量表、老年抑郁量表。 4体位性低血压 卧位血压、心率；立位血压、心率。 5深感觉损害 音叉振动觉。 6平衡障碍 脚跟对脚尖站立(Tandem)：要求一脚的后跟在另一脚趾尖前，成一字形站立并保持30 s。Tandem=4为正常，Tandem≤2有跌倒风险。 行走转髋(GPT)：受试者在正常步态下行走，在听到转身、停止的指令时能够尽可能快地转身面对相反的方向，并停止在这个位置上。GPT=3为正常，GPT≤1有跌倒风险，GPT=0需居家和陪伴。 平衡仪检测。 7步态障碍 计时站起走(TUGT)：在发出开始口令时计时，患者从椅子上站起来，以自己感到舒服的速度向前行走，在3 m处反转，再走回椅子坐下。在正式计时开始前，可以让患者先做一遍熟悉步骤。完成时间≥13.5 s跌倒风险可能增加。TUGT≥30 s是需要有人陪伴的指标。动态步态指数(DGI)：测定动态步态功能状态的量表，<10提示有跌倒风险。 8前庭功能损害 主观：眩晕残障程度评定量表(DHI)；日常活动前庭功能障碍等级。 客观：视频头脉冲试验；冷热试验；旋转试验；摇头眼震。 9视觉障碍 静态视敏度；动态视敏度。 10肌力减退 5次起坐检测：连续5次从坐的椅子上站起来，再坐下，连续5次坐站的时间≥15 s，提示有跌倒风险。 单腿站立指数(SLS)：不用手扶持辅助，单腿独立站立持续时间。中度以上有跌倒风险。 功能性前伸：手臂抬高90°直立站立，测量手指可以达到的位置。仅能前伸5 cm为严重损害，跌倒风险高。
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| 引用本文: |
孙勍, 张清华, 彭新, 等. 防跌倒临床策略[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(2): 108-111. doi: 10.13201/j.issn.2096-7993.2021.02.004
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| Citation: |
SUN Qing, ZHANG Qinghua, PENG Xin, et al. Clinical strategies to prevent falls[J]. J Clin Otorhinolaryngol Head Neck Surg, 2021, 35(2): 108-111. doi: 10.13201/j.issn.2096-7993.2021.02.004
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