两种标准分析老年住院患者的潜在不适当用药

Analysis to Potential Inappropriate Medications of Elderly Inpatients by Two Criteria

目的:采用Beers标准(2015版)、《中国老年人潜在不适当用药判断标准》(简称"中国标准"2017版)分析我院心内科老年住院患者潜在不适当用药(Potential Inappropriate Medication,PIM)的发生情况。方法:将我院心内科2018年1月至3月,年龄≥65岁的住院患者纳入本研究。收集患者年龄、性别、ADL评分、临床诊断、住院医嘱、住院天数、药品费用、总医疗费用等基本信息,分别采用上述两种标准审查老年住院患者的潜在不适当用药发生情况,并应用二元Logistic回归分析PIM发生的相关危险因素。结果:共纳入患者661例,包括男性350例、女性311例,平均年龄73.86±6.55岁,平均用药种类10.17±4.01种,住院天数的区间为3~30天,临床诊断的区间为1~17种。依据Beers标准,387例(58.55%)患者至少发现1项PIM;依据中国标准,542例(82.00%)患者至少发现1项PIM,Logistic结果显示,用药种类是PIM发生的危险因素。结论:联合使用Beers标准与中国标准可审查出更多老年患者应谨慎使用或避免使用的潜在不适当药物,在临床应用中,应结合两种标准给出的用药建议,通过减少或避免潜在不适当药物的应用来减少其可能引起的不良的临床结局。

Objective:To analyze the occurrence of potential inappropriate medication(PIM)of elderly inpatients in our hospital by using the Beers Criteria of 2015 and the criteria of PIM for elderly adults in China(China Criteria,2017).Methods:The patients aged≥65 years at Heart Center of our hospital from January to March,2018 were included in this study.Basic information such as patient age,gender,activity of daily living,clinical diagnosis,medication orders,days of hospitalization,drug expenses and total medical cost were collected.The occurrence of PIM in elderly inpatients was evaluated by using the above two criteria.The logistic regression analysis was used to analyze the related risk factors of PIM occurrence.Results:A total of 661 patients were enrolled into the study,including 350 males and 311 females with an average age of 73.86±6.55 years,an average variety of 10.17±4.01 drugs,an interval of 3 to 30 days of hospitalization,and an interval of 1 to 17 clinical diagnosis.387 patients were found to have at least one PIM by the Beers Criteria,and 542 patients(82.00%)were found to have at least one PIM by the China Criteria.Logistic results showed that the types of medication for elderly patients were the risk factors for PIM.Conclusion:The combined use of the Beers Criteria and the China Criteria can be used to review more potentially inappropriate medications that should be carefully used or avoided in elderly patients.In clinical application,the actual situation should be combined with the recommendations by the two criteria so as to avoid or reduce the incidence of potential adverse reactions.