血管性轻度认知障碍老年人双重任务行走下步态参数特征与跌倒的关系

doi:10.3969/j.issn.1006-9771.2020.04.015

摘要/Abstract

摘要：

目的探讨血管性轻度认知障碍(VaMCI)老年患者双重任务行走下步态参数特征与跌倒的关系。方法 2019年3月至9月,采用便利抽样法选择符合标准的103例VaMCI老年患者,按照过去1年有无跌倒情况,分为跌倒组(n = 45)和未跌倒组(n = 58)。对两组进行一般资料调查,采用改良Barthel指数(MBI)、计时起立行走测试(TUGT)进行评定,并采用便携式步态分析仪采集双重任务行走状况下的步态参数。结果未跌倒组MBI显著高于跌倒组(t = 35.688, P <0.001),TUGT所用时间短于跌倒组(t = 2.428, P <0.05)。未跌倒组步速、步长、步频、摆动相和地面冲击力均大于跌倒组(t > 2.536, | Z| > 1.986, P < 0.05),单步时间和站立相小于跌倒组(| Z| > 2.440, P < 0.05)。步速、步长、步频、单步时间是跌倒发生的独立危险因素( P <0.05)。结论双重任务下的步态参数特征可反映VaMCI老年患者步行能力,提示跌倒风险。应当重视步速、步长、步频、单步时间相关参数变化并及时采取有效措施评估及干预。

关键词: 认知障碍, 双重任务, 老年人, 步态

Abstract:

Objective To investigate the relationship between gait parameters under dual-task condition and falls in old patients with vascular mild cognitive impairment (VaMCI).Methods From March to September, 2019, convenience sampling method was adopted to select 103 old patients with VaMCI. They were divided into falling group (n = 45) and non-falling group (n = 58), according to the situation of falling in the past one year. Both groups were surveyed general data, assessed with modified Barthel Index (MBI) and Timed “Up and Go” Test (TUGT), and collected gait parameters under dual-task condition. Results MBI score was significantly higher (t = 35.688, P <0.001), and the time of TUGT was shorter (t = 2.428, P <0.05) in the non-falling group than in the falling group. The speed, length, frequency, swing phase and ground impact were higher (t > 2.536, | Z| > 1.986, P < 0.05), and single step time and the stance phase were lower (| Z| > 2.440, P < 0.05) in the non-falling group than in the falling group. Speed, length, frequency and single step time were risk factors for falling ( P <0.05).Conclusion The characteristics of gait parameters under dual-task condition could reflect the walking ability of the old patients with VaMCI, suggesting the risk of fall, especially speed, length, frequency and single step time, which need to be measured and intervened in time.

Key words: cognitive impairment, dual task, aging, gait

中图分类号:

R743

朱玲玲,绳宇. 血管性轻度认知障碍老年人双重任务行走下步态参数特征与跌倒的关系[J]. 《中国康复理论与实践》, 2020, 26(4): 467-471.

ZHU Ling-ling,SHENG Yu. Gait Characteristics under Dual-task Condition and Their Relationship with Fall among Old Patients with Vascular Mild Cognitive Impairment[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(4): 467-471.

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项目	跌倒组 (n = 45)	未跌倒组 (n= 58)	χ²/t值	P值
年龄(岁)	69.14±6.25	68.92±6.45	-0.147	0.084
性别(n)			0.192	0.662
男	30	41
女	15	17
文化程度(n)			5.347	0.148
小学以下	4	7
初中	19	16
高中(含中专)	8	21
大学(含大专)以上	14	14
居住方式(n)			2.821	0.244
独居	2	6
与老伴同住	29	41
与子女同住	14	11
家庭人均月收入(n)			1.577	0.665
0~3000元	5	6
3001~6000元	11	18
6001~8000元	19	18
8001元以上	10	16
疾病史(n)
高血压			3.224	0.073
有	36	37
无	9	21
糖尿病(n)			1.570	0.210
有	21	20
无	24	38
高脂血症(n)
有	15	19	0.004	0.951
无	30	39

项目	n	MBI	TUGT(s)
跌倒组	45	96.57±3.28	18.23±1.37
未跌倒组	58	98.68±2.38	17.50±1.67
t值		35.688	2.428
P值		<0.001	0.017

项目	跌倒组(n= 45)	未跌倒组(n = 58)	Z/t值	P值
步速(m/s)	0.39±0.14	0.51±0.14	4.318	<0.001
步长(cm)	71.00±16.80	78.80±14.35	2.536	0.013
步频(/min)	0.39±0.14	0.51±0.14	4.318	<0.001
跨步长(m)	0.63(0.58, 0.78)	0.66(0.50, 0.82)	-0.127	0.899
跨步时间(s)	1.73(1.67, 1.87)	1.61(1.43, 1.77)	-1.178	0.239
单步时间(s)	0.86(0.74, 1.03)	0.78(0.69, 0.90)	-2.440	0.015
站立相(%)	71(66.25, 73.59)	67.29(65.29, 69.96)	-2.791	0.005
摆动相(%)	29(26.41, 36.76)	32.71(29.95, 34.71)	-2.818	0.005
地面冲击力(G)	0.39(0.33, 0.68)	0.51(0.38, 0.84)	-1.986	0.047

变量	B	SE	Wald	P	OR	95%CI
步速	-6.199	1.636	14.353	<0.001	0.002	0.000~0.050
步长	-9.752	3.285	8.811	0.003	0.000	0.000~0.036
步频	-0.033	0.014	5.252	0.022	0.968	0.941~0.995
单步时间	3.082	1.284	5.758	0.016	21.803	1.759~27.298