基于《老年人围手术期高风险用药目录》的高龄骨科患者长期用药评估

Long-term Medication Evaluation of Elderly Orthopedics Patients based on The List of High-risk Perioperative Medications for Elders in China

目的:基于《老年人围手术期高风险用药目录》,对拟行骨科手术的高龄患者的长期用药进行评估,优化用药方案,减少围手术期药物相关风险。方法:通过访谈方式收集2017年7月~2020年12月入住首都医科大学宣武医院骨科,符合入排标准高龄患者(≥75岁)的用药信息,以《老年人围手术期高风险用药目录》为评价标准,分析患者的高风险用药情况。结果:共纳入503例患者,男190例,平均年龄(80.30±3.96)岁。共检出389例(77.3%)患者使用高风险药物,涉及1 074例次用药。其中241例(47.9%)使用2~4种高风险药物,53例(10.5%)使用≥5种。高风险用药共涉及10大类51种/类药物,其中血管紧张素转化酶抑制药(ACEI)/血管紧张素拮抗药(ARB)、阿司匹林和β受体阻断药用药频次较高。对于药物围手术期潜在风险进行分析,增加谵妄、跌倒和认知功能受损风险的药物多为镇静催眠抗焦虑药;增加出血风险的药物中,阿司匹林、非甾体抗炎药(NSAIDs)和氯吡格雷占比较高;增加肾功能损害的药物中,用药频次最高的是ACEI/ARB和NSAIDs。结论:本院拟行手术的高龄骨科患者存在一定的药物相关风险,临床药师应协助医生加强老年患者长期用药的方案优化,尽量规避和减少用药风险,促进合理用药。

Objective:Based on The List of High-risk Perioperative Medications for Elders in China, to evaluate the long-term medications of elderly patients who were planning to undergo orthopedic surgery in order to optimize the medication regimen before surgery and reduce the risks associated with perioperative medication. Methods:The medication information of elderly patients(≥75 years) who met the admission and discharge criteria, and were admitted to Xuanwu Hospital of Capital Medical University from July 2017 to December 2020 was collected through interviews. The high-risk medication status was analyzed using the medication list aforementioned. Results:A total of 503 patients were included in this study, including 190 males and with a mean age of(80.30±3.96) years. A total of 389 patients(77.3%) were found to use high-risk drugs preoperatively, involving a total of 1 074 times of medication. Among them, 241 patients(47.9%) received 2 to 4 high-risk drugs, and 53 patients(10.5%) received 5 or more high-risk drugs. A total of 51 drugs/classes of 10 categories were involved in high-risk drugs, among which ACEI/ARB, aspirin and β-blockers were used most frequently. For the analysis of the potential risks of perioperative drug use, the drugs that increased the risk of delirium, falls and cognitive impairment were sedative, hypnotic and antianxiety drugs at most. Among drugs that increased the risk of bleeding, aspirin, NSAID and clopidogrel respectively accounted for 25.9%, 13.5% and 7.0%. Among the drugs that increased renal function impairment, ACEI/ARB(151 cases) and NSAIDs(68 cases) were the most frequently used.Conclusion: The elderly patients who plan to undergo orthopedic surgery in our hospital have certain preoperative medication risks. Clinical pharmacists should assist surgeons in strengthening the optimization of long-term medication plans for elderly patients, the purpose is avoiding and reducing medication risks as far as possible, and promoting rational drug use.