老年患者药品不良反应及潜在不适当用药分析

Analysis of Adverse Drug Reactions and Potential Inappropriate Medication in Elderly Patients

目的分析发生药品不良反应(ADR)的老年患者的潜在不适当用药(PIM)现象,为临床合理用药提供参考。方法收集2016年1月~2018年12月上报国家不良反应监测网的ADR报告老年患者ADR报告238例,记录患者基本信息及ADR等级、分析引起ADR的可疑药品、ADR累及的器官或系统和临床表现、ADR转归,按照《中国老年人潜在不适当用药判断标准(2017年版)》判断PIM发生情况。结果ADR发生率男性高于女性,ADR等级:新的77例(32.35%);一般的192例(80.67%);严重的46例(13.93%);剂型以注射剂多见,药物以抗菌药物居多,ADR主要累及的器官或系统依次是皮肤及其附件、其次是消化系统、中枢神经系统等;238例ADR中,痊愈101例(42.43%),好转115例(48.32%),不详18例(7.56%),未好转4例(1.68%);189例患者(79.41%)存在PIM现象,共计280项,有73例(30.67%)存在2项以上PIM,其中使用A级警示药物122例,共计176项,使用B级警示药物67例,共计91项;使用与疾病状态相关的PIM A级警示药物12例,共计13项,B级警示药物0例。结论PIM现象在发生药品不良反应的老年患者中较多见,临床应重视相关药品的药学监护工作。重视用药个体化,分清疾病的缓急,精简药物处方,注意PIM问题特别是疾病状态下PIM情况,合理用药减少ADR的发生,ADR发生后应及时准确持续的追踪ADR转归,确保ADR监测数据的完整性。

Objective To analyze the potential inappropriate medication(PIM)phenomenon in elderly patients with adverse drug reactions(ADR),and provide a reference for clinical rational medication.Methods Collecting 238 ADR reports of elderly patients who reported to the National Adverse Reaction Monitoring Network from January 2016 to December 2018,record basic patient information and ADR grade,analyze suspicious drugs causing ADR,the organs or systems involved in ADR and their clinical manifestations,ADR outcomes,and the occurrence of PIM should be judged according to the"Judgment Criteria for Potentially Inappropriate Medications for Chinese Elderly People(2017 Version)".Results The incidence of ADR is higher in males than in females.ADR grade:new 77 cases(32.35%);general 192 cases(80.67%);severe 46 cases(13.93%);dosage forms are more common in injections,and drugs are mostly antibacterial drugs,The main organs or systems involved in ADR are skin and its accessories,followed by digestive system,central nervous system,etc.Among 238 cases of ADR,101 cases were recovered(42.43%),115 cases were improved(48.32%),and 18 cases were unknown(7.56%),did not improve in 4 cases(1.68%);189 patients(79.41%)had PIM phenomenon,a total of 280 items,and 73 cases(30.67%)had more than 2 PIM,including 122 cases of A-level warning drugs,a total of 176 items,67 cases using B-level warning drugs,a total of 91 items;12 cases using PIM A-level warning drugs related to disease status,a total of 13 items,0 cases of B-level warning drugs.Conclusion PIM phenomenon is more common in elderly patients who have adverse drug reactions,and clinical attention should be paid to the pharmaceutical monitoring of related drugs.Pay attention to the individualization of medication,distinguish the urgency of the disease,simplify the drug prescription,pay attention to PIM problems,especially the PIM situation in the disease state,rationally use drugs to reduce the occurrence of ADR,after the occurrence of ADR,the ADR should be tracked accurately and continuously in time to ensure the monitoring data of ADR completeness.