摘要
目的:了解住院老年患者潜在不适当用药情况并探讨相关危险因素。方法收集清华大学第一附属医院老年内科2013年10月至2014年5月出院的65岁以上老年患者病历资料进行回顾性分析。依据美国老年医学会2012年版 Beers 标准,凡住院期间使用了该标准中老年患者潜在不适当用药目录中的药物和老年患者与疾病状态相关的潜在不适当用药目录中的药物,即判断为潜在不适当用药。采用 Logistic 回归方法分析潜在不适当用药的危险因素。结果纳入分析的患者共217例,男性120例(55.3%),女性97例(44.7%);年龄65~97岁,平均(80±6)岁;罹患疾病3~14种,其中3~5种者52例(23.96%),6~10种者141例(64.98%),11~14种者24例(11.1%),平均(7±3)种;住院时间4~57 d,平均(17±10)d;用药2~49种/ d,其中2~5种/ d 者33例(15.2%),6~10种/ d 者84例(38.7%),>10种/ d 者100例(46.1%),平均(12±8)种/ d。217例患者中79例(36.4%)使用了2012 Beers 标准中老年患者潜在不适当用药目录中的药物,涉及老年人避免使用的药物16种,累计76个潜在不适当用药,其中使用率最高的是镇静催眠药[51.3%(39/76)]。79例存在潜在不适当用药的患者中,42例使用了 Beers 标准中老年患者与疾病状态相关的潜在不适当用药目录中的药物,涉及18种药物,累计62个潜在不适当药物,涉及的疾病状态有骨折、痴呆、失眠、便秘、心力衰竭、前列腺增生、谵妄、慢性肾病和帕金森病。Logistic 回归分析结果显示潜在不适当用药的危险因素为患者住院天数(OR =1.06,95% CI:1.022~1.094,P =0.001)、罹患疾病种数(OR =1.15,95% CI:1.014~1.302,P =0.03)和日均用药种数(OR =1.05,95% CI:1.005~1.104,P =0.03)。结论住院老年患者潜在不适当用药发生率较高,其危险因素为患者住院天数、罹患疾病种数和日均用药种数。
Objective To investigate the potentially inappropriate medications(PIM)and their risk factors in elderly inpatients. Methods The medical record data of patients ≥ 65 years,who were discharged from the Department of Geriatrics in Tsinghua University First Hospital between October 2013 and May 2014,were collected and retrospectively studied. The PIM and PIM related to certain diseases were evaluated according to the 2012 Beers criteria. Multivariate logistic regression were performed to analyze the risk factors of PIM. Results A total of 217 patients were enrolled in this study. Of them,120(55. 3% ) were males and 97(44. 7% )were females with age from 65 to 97 years and their average age was(80 ± 6) years. In the 217 patients,the disease categories were 3 to 14 in each patient,3-5 in 52 patients (24. 0% ),6-10 in 141 patients(65. 0% ),11-14 in 24 patients(11. 1% ),and the average category was 7 ± 3. The hospitalization time was 4-57 days with average time of(17 ± 10)days in each patient. In the 217 patients,the categories of drugs were 2-49 each day in each patient,2-5 kinds in 33 patients (15. 2% ),6-10 in 84 patients(38. 7% ),〉 10 kinds in 100 patients(46. 1% ),and the average category was 12 ± 8. In the 217 patients,79 patients(36. 4% )received PIM listed in the 2012 Beers criteria,16 kinds of drugs were involved and cumulative 76 PIMs were found. Of them,the most wildly used drugs were sedatives and hypnotics[51. 3%(39 / 76)]. In the 79 patients with PIM,42 patients were given PIMs related to certain diseases in the 2012 Beers criteria,18 kinds of drugs were involved and cumulative 62 PIM involving disease status such as fracture, dementia, insomnia, constipation, heart failure, prostatic hyperplasia,delirium,chronic kidney disease,and Parkinson's disease. Logistic regression analysis showed that the risk factors of PIM were hospitalization time(OR = 1. 06,95% CI:1. 022-1. 094,P = 0. 001), disease categories(OR = 1. 15,95% CI:1. 014-1. 302,P = 0. 03),and daily used drug categories(OR =1. 05,95% CI:1. 005-1. 104,P = 0. 03). Conclusion The incidence of PIMs in elderly inpatients was high and its risk factors are hospitalization time,disease categories and daily used drug categories.
出处
《药物不良反应杂志》
CSCD
2016年第3期170-174,共5页
Adverse Drug Reactions Journal
关键词
老年人
潜在不适当用药目录
Aged
Potentially inappropriate medication list