老年肿瘤患者潜在不适当用药的影响因素分析

Analysis of influential factors for potentially inappropriate medication in elderly cancer patients

目的分析老年肿瘤患者潜在不适当用药(PIM)的影响因素。方法收集某院2021年1-12月住院治疗的老年肿瘤患者资料,采用2019年美国老年医学会的Beers标准(以下简称“2019版Beers标准”)和《中国老年人潜在不适当用药判断标准(2017年版)》(以下简称“中国PIM标准”)对患者的PIM进行分析,采用多因素Logistic回归分析PIM的影响因素。结果共纳入293例患者。参照2019版Beers标准,有211例患者(72.01%)存在PIM,其中204例(69.62%)存在与药物相关的PIM,6例(2.05%)存在与疾病或症状有关的PIM,46例(15.70%)存在应谨慎使用药物的PIM,32例(10.92%)存在应避免的药物-药物相互作用的PIM,11例(3.75%)存在基于肾功能的PIM;发生例次居前5位的药物分别为质子泵抑制剂、甲氧氯普胺、异丙嗪等第1代抗组胺药、布洛芬等止痛药物、甲地孕酮。参照中国PIM标准,有132例患者(45.05%)存在PIM;119例(40.61%)存在与药物相关的PIM,涉及25种药物,其中高风险药物7种、低风险药物18种;24例(8.19%)存在疾病状态下PIM;发生例次居前4位的药物分别为异丙嗪、甲地孕酮、布洛芬和西咪替丁。多因素Logistic回归分析结果显示,与住院时间≤10 d比较,住院时间11~30 d的患者发生PIM的风险较高[优势比(OR)=8.8368,95%置信区间(CI)(3.2178,31.9409),P=0.0001];与临床疾病诊断≤5种比较,临床疾病诊断≥11种的患者发生PIM的风险较高[OR=10.9301,95%CI(3.0009,70.9229),P=0.0018];与手术治疗比较,接受抗瘤药物治疗的患者发生PIM的风险较高[OR=2.2095,95%CI(1.1802,4.1769),P=0.0136]。结论老年肿瘤患者合并多种疾病,用药复杂,PIM发生率较高;住院时间(11~30 d)、临床疾病诊断数(≥11种)、抗肿瘤药物治疗是其发生PIM的主要影响因素。

OBJECTIVE To analyze the influential factors for potentially inappropriate medication(PIM)in elderly cancer patients.METHODS The data of elderly cancer patients hospitalized in a hospital from January to December 2021 were collected.According to the Beers standard of the American Geriatrics Society in 2019(hereinafter referred to as the“2019 version of Beers standard”)and Criteria for Potentially Inappropriate Drug Use in Chinese Elderly(2017 version)(hereinafter referred to as the“Chinese PIM standard”),the PIM status of elderly cancer patients was retrospectively analyzed.Multivariate Logistic regression analysis was used to identify influential factors for PIM.RESULTS A total of 293 patients were included in the study.According to the 2019 version of Beers standard,211 patients(72.01%)had PIM,of which 204(69.62%)had PIM related to drugs,6(2.05%)had PIM related to diseases or symptoms,46(15.70%)had PIM that should be used with caution,32(10.92%)had PIM with drug-drug interaction that should be avoided,and 11(3.75%)had PIM based on renal function;the top 5 drugs in the list of incidence were proton pump inhibitors,metoclopramide,the first-generation antihistamines as promethazine,analgesics as ibuprofen and megestrol.According to the Chinese PIM standard,there were 132 patients(45.05%)with PIM,of which 119(40.61%)had PIM related to drugs,involving 25 drugs(included 7 high-risk drugs and 18 low-risk drugs),and 24(8.19%)with PIM in disease status;top 4 drugs in the list of incidence were promethazine,megestrol,ibuprofen and cimetidine.Multivariate Logistic regression analysis showed that compared with patients with hospital stay≤10 days,patients with hospital stay between 11 and 30 days had a higher risk of PIM[odds ratio(OR)=8.8368,95%confidence interval(CI)(3.2178,31.9409),P=0.0001];compared with the patients with the number of clinical disease diagnosed≤5,patients with the number of clinical disease diagnosed≥11 had a higher risk of PIM[OR=10.9301,95%CI(3.0009,70.9229),P=0.0018];compared with surgical treatment,patients receiving antineoplastic drugs had a higher risk of PIM[OR=2.2095,95%CI(1.1802,4.1769),P=0.0136].CONCLUSIONS Elderly cancer patients have multiple diseases,complicated medication,and a high incidence of PIM.The length of hospital stay(11-30 d),the number of clinical disease diagnosed(≥11)and anti-tumor drugs are main influential factors for PIM in patients.