2016~2020年中国九城市老年失眠患者镇静催眠类药物使用趋势分析

Trends in Prescribing of Sedative-hypnotic Drugs in Elderly Patients with Insomnia in Nine Cities of China from 2016 to 2020

目的:了解镇静催眠类药物在老年人群中的使用现状,为进一步促进其合理使用提供依据。方法:随机抽取参加《医院处方分析合作项目》的中国九城市119家医院2016~2020年年龄≥60岁患者,诊断为失眠,包含有镇静催眠类药物的处方,分析各类镇静催眠药物各年的使用频次、比例及复合年增长率,不同组合治疗方案的各年频次及比例,各种药物的平均日剂量(PDD),非苯二氮[艹卓]类苯二氮[艹卓]受体激动药(non-BZDs)和苯二氮[艹卓]类药物(BZDs)品种选择的相关因素。结果:老年失眠患者处方中BZDs各年用药频次及构成比均居于首位,构成比呈逐年缓慢下降趋势;治疗方案各年均以单类药物的治疗为主(>90%),联合治疗方案以苯二氮[艹卓]受体激动药(BZRAs)间的联用(2.81%~3.87%)以及BZRAs与抗抑郁药的联用为主(0.93%~1.09%);处方中70.6%(12/17)的镇静催眠类药物PDD≤限定日剂量(DDD),29.4%(5/17)的药物PDD>DDD;根据多因素分析,一线城市较非一线城市[OR=0.510,95%CI(0.502,0.518)],男性较女性[OR=0.969,95%CI(0.955,0.983)],可报销药费患者较自费患者[OR=0.750,95%CI(0.738,0.761)]开具BZDs比例较低,而一级医院[OR=1.337,95%CI(1.280,1.396)]、二级医院[OR=1.320,95%CI(1.284,1.356)]较三级医院、神经精神疾病科室较非神经精神疾病科室[OR=2.342,95%CI(2.306,2.379)]、年龄≥75岁[75~89岁:OR=1.166,95%CI(1.149,1.183);年龄≥90岁:OR=1.121,95%CI(1.082,1.162)]的老年患者较年龄<75岁老年患者,开具BZDs的比例较高。结论:近5年国内老年患者镇静催眠类药物使用仍以BZDs为主、部分患者存在着多种BZRAs联用,镇静催眠类药物剂量偏大等问题。要改善现状,对于患者和医生的宣教可能是主要途径之一。

Objective:To understand the current status of sedative-hypnotic drugs in the elderly,and to provide a basis for further promoting their rational use.Methods:A random sample was extracted from prescriptions with patients aged≥60 years old,diagnosed with insomnia,including sedative and hypnotics,from 119 hospitals in nine cities of China participating in the“Cooperative Hospital Prescription Analysis Project”from 2016 to 2020 and the annual frequency,proportion and compound annual growth rate of various sedative and hypnotic drugs,the annual frequency and proportion of different combination treatment regimens,the average daily dose(PDD)of various drugs,and relevant factors of choice of non-benzodiazepine benzodiazepine receptors agonists(non-BZDs)and benzodiazepines(BZDs)were analyzed.Results:The annual frequency and composition ratio of BZDs in the prescriptions of elderly patients with insomnia ranked first,and the composition ratio of the frequency of BZDs’use showed a slow decline year by year;the treatment plan was dominated by single-type drugs in each year(>90%),the combination treatment plan was based on the combination of benzodiazepine receptor agonists(BZRAs)(2.81%-3.87%)and the combination of BZRAs and antidepressants(0.93%-1.09%);the PDD of 70.6%of the insomnia drugs was lower than DDD,and the PDD of 29.4%(5/17)of the drugs was higher than DDD.And the multiple-factor analysis showed that the patients in the first-tier cities(OR=0.510,95%CI 0.502 to 0.518),males(OR=0.969,95%CI 0.955 to 0.983),and who could be reimbursed for drug expenses(OR=0.750,95%CI 0.738 to 0.761)were less likely to be prescribed BZDs,patients from first-level hospitals(OR=1.337,95%CI 1.280 to 1.396)and secondary hospitals(OR=1.320,95%CI 1.284 to 1.356),psychiatric and neurological departments(OR=2.342,95%CI 2.306 to 2.379),and older than 75 years old(75-89 years old:OR=1.166,95%CI 1.149 to 1.183;over 90 years old:OR=1.121,95%CI 1.082 to 1.162)tend to be prescribed BZDs.Conclusion:In the past 5 years,domestic elderly patients still use BZDs as the main sedative and hypnotic drugs,and some patients have problems such as the combined use of multiple BZRAs and large doses of insomnia drugs.To improve the status quo,educating patients and doctors may be one of the main solutions.