老年痴呆患者潜在不适当用药分析

Potentially Inappropriate Medication in Senile Dementia Patients

目的评价住院老年痴呆患者潜在不适当用药(PIM)情况。方法采用系统抽样法,收集新疆医科大学附属中医医院2018年1月至2019年12月收治的痴呆和(或)认知功能障碍的住院患者(年龄不小于65岁)398例,分别采用2015年版Beers标准和抗胆碱能认知负担(ACB)量表评价PIM情况,并采用Logistic检验对2种评价结果进行相关性分析,采用Kappa检验对2种评价结果进行一致性检验。结果398例患者中,119例(29.90%)至少存在1种PIM,78例(19.60%)存在认知损害高风险用药情况;2种标准评价PIM发生率最高的均为抗精神病药物;ACB量表评价心血管系统药物及呼吸系统药物也存在认知损害轻度风险;影响因素分析结果表明,住院天数、诊断数量、服药数量增加均使PIM的发生率增加(P<0.05);2种标准评价该次PIM发生率一致性一般(Kappa=0.634)。结论Beers标准与ACB量表在评估老年痴呆患者PIM风险中有重要价值,联合使用可能会进一步提高老年痴呆患者的合理用药水平。

Objective To evaluate the potentially inappropriate medication(PIM)in senile dementia inpatients.Methods A total of 398 senile dementia and/or cognitive impairment inpatients(≥65 years)in the Traditional Chinese Medicine Hospital Affiliated to Xinjiang Medical University from January 2018 to December 2019 were collected according to the systematic sampling method.The Beers criteria(2015)and Anticholinergic Cognitive Burden(ACB)scale were used to evaluate the PIM situation.The Logistic test was used to analyze the correlation between the two evaluation results,and the Kappa test was used to test the consistency of the two evaluation results.Results Among the 398 inpatients,the incidence of at least 1 kind of PIM was 119 cases(29.90%),78 cases(19.60%)had high-risk medications for cognitive impairment;the two criteria for evaluating the highest incidence of PIM were all antipsychotic drugs;the ACB scale evaluation of cardiovascular system drugs and respiratory system drugs also showed a slight risk of cognitive impairment.The risk factor analysis results showed that the increase in the number of hospitalization days,the number of diagnoses,and the number of medications all increased the incidence of PIM(P<0.05);the two criteria that evaluated the consistency of the incidence of this PIM was general(Kappa=0.634).Conclusion Both the Beers criteria and ACB scale have important value in evaluating the PIM risks of senile dementia inpatients.The combined application of the two may further increase the reasonable medication level of senile dementia patients.