对老年2型糖尿病住院患者多重用药相互作用的分析及干预研究

Evaluation of drug-drug interactions in elderly inpatients with type 2 diabetes mellitus by polypharmacy

目的对内分泌科老年2型糖尿病住院患者多重用药的药物相互作用(DDI)进行分析和干预,提高临床用药的有效性和安全性。方法对2017年11月1日至2018年4月30日内分泌科老年2型糖尿病住院患者入院第2天的用药医嘱进行筛查,针对多重用药(全身用药品种≥5种)患者,采用Micromedex和PASS软件对用药医嘱进行药物相互作用的检索,结合患者具体情况对检索结果进行分析,采取相应的干预措施。结果研究共纳入247例住院的老年2型糖尿病多重用药患者(多重用药发生率为94.3%),合并疾病2～33(9±5)种,住院期间服用化学药品5～18(6±3)种,利用Micromedex和PASS软件分别筛出706条和789条药物相互作用(DDI),匹配的DDI总数为262条,匹配率分别为37.1%和33.2%。其中发生DDI频次较高的药物类别有:内分泌系统药物、循环系统药物、血液及造血系统药物等,发生DDI几率较高的药物有比索洛尔、阿司匹林、氢氯噻嗪等。根据患者用药DDI及其他具体情况,对4例患者进行干预,修改给药方案,对150例患者实施密切监护,对93例患者实施常规监护。结论老年2型糖尿病住院患者多重用药发生率高,DDI发生率高。Micromedex和PASS软件在DDI筛查方面各有特点,临床药师应结合使用,并综合患者其他具体情况,综合评估判断,协助医生制定合理的个体化给药方案。

Objective To analyze and intervene the drug-drug interactions of polypharmacy in elderly patients with type 2 diabetes mellitus hospitalized in the Department of Endocrinology,and improve the effectiveness and safety of patients'medications.Methods The prescriptions for elderly patients with type 2 diabetes mellitus hospitalized in the Department of Endocrinology from November 1th,2017 to April 30th,2018 were collected and screened for drug-drug interactions using Micromedex and PASS software,respectively.The DDIs were recorded,analyzed and intervened based on the patients'other individualized situation.Results A total of 247 diabetic patients with polypharmacy(94.3% )were included.The median number of combined diseases was 9±5(ranging 2~33).The median number of chemicals was 6±3(ranging 5~18).Totally 706 and 789 drug-drug interactions(DDI)were found by Micromedex and PASS software,with a total of 262 matched DDIs and a matching rate of 37.1% and 33?2% ,respectively.The categories of medications with high frequencies of DDIs included drugs of endocrine system,circulatory system and hematologic system.The medications with high probability of DDIs included bisoprolol,aspirin and hydrochlorothiazide,etc.Four patients were intervened to change the medication,150 patients were given close monitoring and 93 patients were given routine monitoring.Conclusion Polypharmacy in elderly in patients with type 2 diabetes mellitus is frequent with high frequency of DDIs.Micromedex and PASS software have their own characteristics and should be both used in clinical practice to get the best information.Clinical pharmacists should make comprehensive judgment based on DDI results and other specific conditions of patients,and assist doctors to make accurate and reasonable individualized dosage regimen.