Beers标准回顾性分析老年住院患者潜在不恰当用药

发布时间：2018-04-18 06:48

  本文选题：Beers标准 + 老年患者　； 参考：《大连医科大学》2014年硕士论文

【摘要】：目的：老年人常常多病共存，导致多重用药（polypharmacy），很可能存在潜在不恰当用药（potentially inappropriate medication，PIM），潜在不恰当用药可能会引起药物不良反应（adverse drug reaction，ADR），导致药物不良事件（adverse drugevents，ADEs）、医药费用、住院率和死亡率的增加。本研究应用Beers标准(2012年版)对2013年首次入住我院的439名65岁以上老年患者用药情况进行回顾性分析判断其潜在不恰当用药，了解我院老年患者用药情况，探讨影响老年患者发生潜在不恰当用药的可能因素。 方法：选择2013年1月-2013年12月首次入住大连医科大学附属第一医院干部综合科的患者，共439例为研究对象，年龄65-95岁（平均年龄78.58±7.03岁），其中男262例，年龄65-95岁（平均年龄79.56+7.12岁）；女177例，，年龄65-95岁（平均年龄77.12+6.66岁）；患者住院时间2-30天。排除恶性肿瘤及既往已多次于我院住院的患者。主要以2012年版Beers标准为依据判断潜在不恰当用药，Beers标准未包括的与年龄无关的潜在不恰当用药通过查阅药理学理论及相关文献进行判断。以发生潜在不恰当用药为因变量，以年龄、性别、临床诊断、治疗药物、住院天数、付费方式等因素为自变量，进行多因素非条件Logistic逐步回归模型进行分析。 结果：平均联合用药数为(9.01±4.93)种，最多一人同时应用24种药物，最少没有用药，＜5种79例（18.00%），联合应用≥5种药物达82%，其中5～10种191例（43.51%），11～20种160例（36.45%），＞20种8例（1.82%），45例（10.25%）应用了中药制剂，如丹参川芎嗪、银杏叶提取物、参松养心胶囊等。根据Beers标准，76例（17.31%）发生了82人次潜在不恰当用药，70人（15.95%）存在1种潜在不恰当用药，6人（1.37%）存在2种潜在不恰当用药，其中74例为与诊断或疾病无关的潜在不恰当用药，频率最高的药物为阿普唑仑、艾司唑仑、胺碘酮、多沙唑嗪，8例(1.82%)为与疾病状态相关的潜在不恰当用药。66例（15.03%）使用了老年患者需慎用的药物。Beers标准未包括的其他潜在不恰当用药共23例（5.24%），主要问题为药物间相互作用。Logistic回归分析显示用药数量，男性进入回归方程，且p＜0.05。 结论：Beers标准在评估老年住院患者是否存在潜在用药风险有重要的应用价值，但它并不能代替临床医师的专业判断，多因素影响老年住院患者发生潜在不恰当用药，临床医师应控制这些因素，减少药物相关性问题发生。
[Abstract]:Objective: the elderly often coexist with many diseases and lead to multiple drug use, which may lead to the existence of potentially inappropriate use of inappropriate medicine, which may lead to adverse drug reaction (ADR) and adverse drug events (ADR), and lead to drug adverse events (ADRs), which may lead to the medical expenses, the cost of medicine, and the risk of adverse drug reactions (ADRs), which may be caused by the potential improper use of PIMM, which may lead to adverse drug reactions, which may lead to adverse drug events and adverse events, which may lead to adverse drug events.An increase in hospital and mortality rates.In this study, the Beers standard (2012 edition) was used to analyze the drug use status of 439 patients over 65 years old in our hospital for the first time in 2013.To explore the possible factors affecting the occurrence of potential inappropriate drug use in elderly patients.Methods: a total of 439 patients, aged 65-95 years (mean age 78.58 卤7.03 years, male 262), were selected from January, 2013 to December, 2013, who were admitted to the Department of cadre General, the first affiliated Hospital of Dalian Medical University for the first time.The patients were aged 65-95 years (mean 79.56 7.12 years old) and 177 women (65-95 years old) (mean age 77.12 6.66 years old). The patients were hospitalized for 2-30 days.Exclude malignant tumors and patients who have been hospitalized in our hospital many times before.According to the 2012 Beers standard, the potential inappropriate drug was judged by consulting the pharmacological theory and related literature, which was not included in the Beers standard.The factors such as age, sex, clinical diagnosis, treatment drug, hospital stay, payment method and so on were taken as independent variables to analyze the multivariate unconditioned Logistic stepwise regression model.Results: the average number of combined drugs was 9.01 卤4.93). At most, 24 drugs were given to one person at the same time, and at least no drugs were used at the same time. < 5 kinds of 79 cases (18.00%) and 鈮

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