老年门诊患者抗胆碱能处方负担评价及其危险因素

Evaluation of anticholinergic burden in elderly outpatients and the risk factors

目的:老年人使用抗胆碱能药物可能会导致跌倒、谵妄、尿潴留和认知功能下降等负面事件,使用抗胆碱能药物数量越多,出现这类负面事件越多。本研究分析老年门诊患者抗胆碱能药物处方的相关危险因素,并进行抗胆碱能药物合理性评价,为降低抗胆碱能药物不良反应提供参考。方法:根据Beers标准制订具有抗胆碱能活性的药物清单,从医院电子病历中提取门诊老年人的基本情况(年龄、性别)、临床诊断、治疗药物等数据,并使用抗胆碱能认知负荷量表(Anticholinergic Cognitive Burden,ACB)计算每位患者的抗胆碱能负担。利用logistics回归分析多重用药、失眠等发生的潜在危险因素。结果:共对1840份老年患者处方进行了审查,其中648名(35.22%)患者ACB评分≥1。处方药品数(95%CI:1.221~1.336)、失眠(95%CI:3.538~6.089)是影响ACB评分的独立危险因素(均P<0.01)。ACB评分的患者治疗用药最常见为中枢神经系统药物(阿普唑仑、艾司唑仑)和心血管系统药物(美托洛尔、硝苯地平)。结论:门诊老年患者使用抗胆碱能活性的药物比例较高。临床上应重点关注多重用药处方及其审核工作,特别是作用于中枢神经系统药物(阿普唑仑、艾司唑仑等)和心血管系统药物(美托洛尔、硝苯地平等),以便降低老年患者抗胆碱能药物的不良反应。

Objective:The use of anticholinergic drugs in the elderly may lead to negative events such as falls,delirium,urinary retention and cognitive decline,and the higher the number of anticholinergic drugs use,the more such negative events occur.This study aims to analyze the risk factors associated with the prescription of total anticholinergic drugs in elderly outpatients and evaluate the rationality of anticholinergic drugs,and to provide a reference for reducing the adverse effects of anticholinergic drugs.Methods:A list of drugs with anticholinergic activity based on the Beers criteria was established.The basic information(such as age and gender),clinical diagnosis,and medications of elderly outpatient were extracted from hospital electronic medical records,and the Anticholinergic Cognitive Burden(ACB)Scale was used to calculate the anticholinergic burden for each patient.Logistic regression analysis was used to identify the potential risk factors for the occurrence of problems such as multiple medication and insomnia.Results:A total of 1840 prescriptions for elderly patients were reviewed.Of these patients,ACB score was more than or equal to 1 in 648(35.22%)patients.Number of prescription medication(95%CI:1.221 to 1.336)and insomnia(95%CI:3.538 to 6.089)were independent factors affecting ACB scores(both P<0.01).Medications for patients of ACB scores were most commonly treated with the central nervous system drugs(such as alprazolam and eszopiclone)and for the cardiovascular system drugs(such as metoprolol and nifedipine).Conclusion:There is a high rate of ACB drugs use in geriatric patients,and the clinical focus should be on multiple medication prescriptions,especially on the central nervous system drugs(such as alprazolam and eszopiclone)and cardiovascular system drugs(such as metoprolol and nifedipine).The prescription review should be emphasized to reduce adverse reactions to anticholinergic drugs in elderly patients.