高龄老年患者不合理用药情况调查及影响因素分析

Investigation of irrational drug use in elderly patients and analysis of influence factors of potentially inappropriate medications andinfluence factors analysis of potential inappropriate medication in geriatric patients in senile people

目的高龄老年患者(≥80岁)多重用药比例及不合理用药问题明显。文中旨在通过调查分析高龄老年患者潜在不适当用药(PIM)的发生情况,探讨影响高龄老年患者发生PIM的可能因素。方法回顾性分析2016年1月至12月南京军区南京总医院干部一科高龄老年患者918例。依据2015年版Beers标准,对老年患者与疾病状态无关的PIM、老年患者与疾病状态相关的PIM、应慎用的PIM、应避免的非抗感染药物联合使用等情况进行评价,并对PIM影响因素进行多因素回归分析。结果高龄老年患者与疾病无关的PIM共521例次(56.75%),最易发生PIM前3位的药物为短效和中效作用苯二氮艹卓、质子泵抑制剂、长效作用苯二氮艹卓;与疾病状态相关的PIM共206例次(22.4%),最易发生PIM前2位的药物为与失眠相关的口服减充血剂、兴奋剂、茶碱、咖啡因及与痴呆或认知障碍相关的抗胆碱能药物、H2受体拮抗剂等;应慎用的PIM共834例次(90.85%);应避免的非抗感染药物的联合使用共45例次(4.90%);基于肾功能应尽可能避免或减少剂量的非抗感染药物共45例次(4.90%)。联合用药数(OR=5.331,95%CI:3.549~8.009)、年龄(OR=1.171,95%CI:1.093~1.249)、查尔森合并症指数评分(OR=1.964,95%CI:1.477~2.450)是PIM发生的危险因素(P<0.05)。结论高龄老年患者PIM发生率较高,减少联合用药数是避免高龄老年患者不合理用药发生的重要措施。

Objective The proportion of multiple drugs and the irrational use of drugs increased significantly in the elderly patients （over 80 years）. This study aimed to investigate the occurrence of potentially inappropriate medication （PIM） and analyzed the possible reasons related to PIM in elderly patients. Methods In this study, 918 cases from Cadre Ward I of Research Center for Geriatrics of Nanjing General Hospital of Nanjing Military Region were selected from January to December in 2016. According to the Beers Criteria （Version 2015）, we evaluated PIM in four subtypes , type 1 that is not related to the state of disease in elderly patients,type 2 that is related to the state of disease in elderly patients, type 3 which should be used carefully, and type 4 which is the inappropriate combination of non-anti-infective Drugs. The PIM influence factors were analyzed by logistic regression analysis. Results There are 521 cases （56.75%） of type 1 PIM. The first 3 drugs are Short and medium acting benzodiazepams, PPI and long acting benzodiazepams. There are 206 cases （22.4%） of type 2 PIM. The first 2 drugs are drugs associated with insomnia （oral hyperemia, stimulants, theo-phylline and caffeine） and drugs associated with dementia or cognitive impairment （anti-cholinergic drugs and H2 receptor antago- nists）. There are 834 cases （90.85%） of type 3 PIM, which should be used carefully and 45 cases （4.90%） of type 4 PIM. 45 cases （4.90%） of non-anti-infective drugs should be avoid or reduced as much as possible in consideration of renal function. The number of combined drug use （ OR = 5.331, 95% CI ： 3.549-8.009）, the age （ OR = 1.171, 95% CI ： 1.093-1.249）, the Chalson＇s comorbidity index （OR= 1.964, 95% CI：1.477-2.450） are risk factors of PIM. Conclusion The incidence of potentially inappropriate use of drugs is high among the elderly patients. Reducing the number of combined drugs is an important measure to avoid the occurrence of PIM in elderly patients.