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目的 以2种不同的评价标准探讨高龄老年住院患者潜在不适当用药（PIM）和潜在处方遗漏（PPO）情况，为规范高龄老年患者药物治疗管理提供依据。方法 以Beers标准（2019版）和STOPP/START标准（2014版）为评判依据，分析2021年1至12月在老年病科住院且年龄>80岁患者的PIM和PPO情况。结果 在124例患者中，用Beers标准检出85例（68.50%）患者存在PIM，共发生PIM 134例次；20例（16.13%）患者存在与疾病相关的PIM，共发生与疾病相关的PIM 22例次。用STOPP/START标准检出46例（37.10%）患者存在PIM，共发生PIM 54例次；24例（19.35%）患者存在PPO，共发生PPO 32例次。2种筛查结果均显示，涉及PIM频率较高的药物为苯二氮?类。用Beers标准检测出与疾病相关的PIM中，心力衰竭患者应用地尔硫?、阿司匹林和西洛他唑占比为36.36%；应用START标准筛查出同时存在一个或多个主要心血管风险因素的糖尿病患者未接受他汀类药物治疗的PPO占比为28.13%。Logistic回归分析显示，用药品种数是PIM发生的危险因素。用Beers标准和STOPP/START标准的筛选方法一致性较差（Kappa=0.338,P <0.001）。结论 高龄老年患者治疗过程中存在的PIM和PPO问题应引起重视，需要加强对高龄老年患者的药物治疗管理。Beers标准和STOPP/START标准在一定程度上能够互相补充，可以更全面地筛选出PIM以及PPO问题。
Abstract：AIM To investigate the potential inappropriate medication(PIM) and potential prescription omission(PPO) in ederly inpatients by using 2 different evaluation criterias, so as to provide reference for the standardization of clinical medication in older patients. METHODS The PIM and PPO status of inpatients(aged > 80 years) discharged from department of geriatrics from January to December 2021 were analyzed based on Beers criteria(2019 edition) and STOPP/START criteria(2014 edition). RESULTS Among 124 patients, the Beers criteria identified 134 PIM in 85patients(68.50%); 20 patients(16.13%) had disease-related PIM, with a total of 22 occurrences. The STOPP/START criteria detected 54 PIM in 46 patients(37.10%); 24 patients(19.35%) existed PPO, with a total of 32 occurrences. The results of both screening methods showed that the drugs involved in a higher frequency of PIM was benzodiazepines(BDZs). In disease-related PIM, 36.36% of heart failure patients were treated with diltiazem, aspirin and cilostazol by Beers criteria. The PPO of diabetes patients with one or more major cardiovascular risk factors without receiving statin treatment accounted for 28.13% by START criteria. Logistic regression analysis indicated that the number of drug varieties was the risk factor for PIM. Beers criteria and STOPP/START criteria had poor consistency in results(Kappa = 0.338,P < 0.001). CONCLUSION PIM and PPO in the treatment of ederly hospitalized patients should be taken seriously, and the management of pharmacotherapy also needs to be strengthened. The Beers criteria and STOPP/START criteria can complement each other to a certain extent, allowing for a more comprehensive screening of PIM and PPO.
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基本信息:
DOI：10.19577/j.1007-4406.2023.06.003
中图分类号:R95
引用信息:
[1]王研,刘霞,林艳,等.基于Beers标准和STOPP/START标准评价高龄老年住院患者潜在不适当用药[J].中国临床药学杂志,2023,32(06):412-417.DOI:10.19577/j.1007-4406.2023.06.003.
2023-06-25
2023-06-25