某院心内科老年患者潜在不适当用药情况及影响因素分析

Analysis of Potentially Inappropriate Medications and Influencing Factors in Elderly Patients in the Department of Cardiology in a Hospital

目的评价医院心内科老年患者潜在不适当用药(PIM)情况,并分析其影响因素。方法通过医院信息系统抽取2021年4月至12月医院心内科老年出院患者电子病历,收集患者的姓名、性别、年龄、住院天数、诊断、用药、相关检验数据及不良反应发生等情况,依据《中国老年人潜在不适当用药判断标准(2017年版)》判断与药物相关及与疾病状态相关PIM的发生情况,归纳其特点,应用多因素Logistic回归分析评估PIM发生的危险因素。结果共纳入患者222例,其中男103例,女119例;年龄60~96岁,平均75(68,81)岁;住院天数3~22 d,平均9(7,11)d;诊断1667条,平均7(6,9)条;用药5~29种,平均14(11,18)种。共出现PIM 215例,213例(489例次)与药物相关,其中A级、B级警示药物分别发生185例、102例(两者兼有74例),涉及药物21类;发生与疾病状态相关的PIM 65例,85例次,涉及疾病状态9类,其中A级、B级警示疾病分别有8类、1类。单因素分析结果提示,与药物相关PIM的影响因素仅用药种数;与疾病状态相关PIM的影响因素包括年龄、用药种数、诊断数(P<0.05);多因素Logistic回归分析结果提示,用药种数[OR=1.304,95%CI(1.073,1.585),P=0.008]是与药物相关PIM的影响因素;年龄[OR=0.951,95%CI(0.915,0.989),P=0.012],诊断数[OR=1.134,95%CI(1.004,1.281),P=0.043],用药种数[OR=1.078,95%CI(1.013,1.147),P=0.018]是与疾病状态相关PIM的影响因素。结论该院心内科老年患者PIM发生率较高,患者年龄、用药种数、诊断数均与PIM的发生相关,临床医师和药师均需加强风险意识,提高患者用药合理性,减少PIM发生。

Objective To evaluate the potentially inappropriate medications(PIMs)among elderly patients in the Department of Cardiology in the hospitals,and to analyze the influencing factors of PIMs.Methods The elderly patients discharged from the Department of Cardiology in the hospital from April to December 2021 were extracted by the hospital information system.The patients′name,gender,age,length of hospital stay,diagnosis,medication,relevant test data and incidence of adverse reactions were collected.Based on the Criteria of Potentially Inappropriate Medications for Older Adults in China(2017 Edition),the occurrence of drug-related and disease status-related PIMs were evaluated,and its characteristics were summarized.The multivariate Logistic regression analysis was used to evaluate the risk factors of PIMs.Results A total of 222 patients were enrolled,including 103 males and 119 females,aged in the range of 60-96 years,with an average of 75(68,81)years.The length of hospital stay was in the range of 3-22 d,with an average of 9(7,11)d;there were 1667 diagnoses,with an average of 7(6,9)diagnoses;the patients used 5-29 varieties of drugs,with an average of 14(11,18)varieties.There were 215 cases of PIMs,of which 213(489 case times)were related to the drugs,involving 185 cases of A-level and 102 cases of B-level warning drugs(74 cases of both),and 21 varieties of drugs were involved.There were 65 cases(85 case times)of disease status-related PIMs,involving nine kinds of disease statuses,including eight kinds of A-level and one kind of B-level warning diseases,respectively.The univariate analysis showed that the influencing factor of drug-related PIMs was only the variety of medication.The influencing factors of disease status-related PIMs were age,variety of medication and diagnosis number(P<0.05).The multiple Logistic regression analysis showed that the variety of medication[OR=1.304,95%CI(1.073,1.585),P=0.008]was the influencing factor for drug-related PIMs;the age[OR=0.951,95%CI(0.915,0.989),P=0.012],diagnosis number[OR=1.134,95%CI(1.004,1.281),P=0.043]and variety of medication[OR=1.078,95%CI(1.013,1.147),P=0.018]were the influencing factors for disease status-related PIMs.Conclusion The incidence of PIMs in elderly patients in the Department of Cardiology of this hospital is high.The patients′age,variety of medication and diagnosis number are all related to the occurrence of PIMs.Clinical physicians and pharmacists need to strengthen their risk awareness to improve the rationality of patients′medication and decrease the occurrence of PIMs.