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中国人民解放军总医院
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中国人民解放军总医院老年心血管病研究所
中国科技出版传媒股份有限公司
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中华老年多器官疾病杂志编辑委员会
100853, 北京市复兴路28号
电话:010-66936756
传真:010-66936756
E-mail: zhlndqg@mode301.cn
创刊人 王士雯
总编辑 范利
副总编辑 陈韵岱
执行主编 叶大训
编辑部主任 王雪萍
ISSN 1671-5403
CN 11-4786
创刊时间 2002年
出版周期 月刊
邮发代号 82-408
友情链接
王鹏,王青,李放,边萌,陈洁若,路菲,张兰,杨昆.潜在不适当用药与衰弱老年人不良结局的相关分析[J].中华老年多器官疾病杂志,2019,18(8):573~577
潜在不适当用药与衰弱老年人不良结局的相关分析
Correlation analysis of potentially inappropriate medications and adverse outcomes in frail elderly
  
DOI:10.11915/j.issn.1671-5403.2019.08.124
中文关键词:  老年人;潜在不适当用药;衰弱
英文关键词:aged; potentially inappropriate medications; frailty
基金项目:北京市西城区卫生健康委员会科技新星项目(XWKX2018-01)
作者单位E-mail
王鹏 首都医科大学附属复兴医院综合科,北京 100038  
王青 首都医科大学附属复兴医院综合科,北京 100038 fxyywang@ccmu.edu.cn 
李放 首都医科大学附属复兴医院综合科,北京 100038  
边萌 首都医科大学附属复兴医院药剂科,北京 100038首都医科大学附属宣武医院:  
陈洁若 首都医科大学附属复兴医院综合科,北京 100038  
路菲 首都医科大学附属复兴医院综合科,北京 100038  
张兰 药物研究室,  
杨昆 循证医学中心,北京 100053  
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中文摘要:
      目的 评估潜在不适当用药(PIM)与衰弱老年人不良结局的相关性。方法 入选2015年1月至2017年12月首都医科大学附属复兴医院综合科老年衰弱患者226例进行研究,根据美国老年医学会Beers标准(2015版)将患者纳入PIM组(n=169)和非PIM组(n=57),比较2组患者日常生活能力(ADL)、认知功能和查尔森共病指数(CCI)等老年综合评估情况。随访截止2018年12月,不良结局终点事件包括非计划再入院和全因死亡。应用SPSS 23.0统计软件对数据进行分析。Cox回归分析PIM与衰弱患者临床不良结局的相关性,Kaplan-Meier生存曲线分析2组患者生存率的差异。结果 PIM检出率为74.8%(169/226),PIM药物中雷贝拉唑占52.7%(89/169),艾司唑仑占42.6%(72/169)。PIM组较非PIM组患者口服药种类和疾病数明显增多,差异有统计学意义(P<0.05)。Cox 回归分析结果表明PIM(HR=1.425,5%CI 1.005~2.021;P=0.047)、年龄(HR=1.047,5%CI 1.013~1.083;P=0.007)和CCI(HR=1.095,5%CI 1.014~1.182;P=0.021)与不良结局相关。Kaplan-Meier分析表明PIM组与非PIM组衰弱老年患者生存率差异有统计学意义(P=0.033)。结论 PIM与衰弱老年人不良结局相关,应加强衰弱筛查及临床合理用药。
英文摘要:
      Objective To evaluate the correlation between potential inappropriate medications (PIM) and adverse outcomes in frail elderly. Methods A total of 226 elderly suffering from senile debility in Fuxing Hospital from January 2015 to December 2017 were recruited, and then divided into PIM group (n=169) and non-PIM group (n=57) according to Beers Standard of American Geriatrics Association (2015 edition). Their daily living ability (ADL), cognitive function and Charlson comorbidity index (CCI) were compared between the 2 groups. All patients were followed up till December 2018, and unplanned readmission and all-cause death were regarded as the end-points of adverse outcomes. SPSS statistics 23.0 was used for data analysis. Cox regression analysis was employed to analyze the correlation between PIM and adverse outcomes in the frail patients, and Kaplan-Meier survival analysis was applied to analyze the differences in survival rates between the 2 groups. Results The detection rate of PIM was 74.8%(169/226). Rabeprazole accounted for 52.7%(89/169) and Estazolam for 42.6%(72/169) among all PIM drugs. Compared with non-PIM group, the types of oral drugs and the number of diseases were significantly larger in PIM group (P<0.05). Cox regression analysis showed that PIM (HR=1.425, 95%CI 1.005-2.021; P=0.047), age (HR=1.047,5%CI 1.013-1.083; P=0.007) and CCI (HR=1.095, 95%CI 1.014-1.182; P=0.021) were associated with adverse outcomes. Kaplan-Meier analysis showed that there was significant difference in survival rate between PIM group and non-PIM group (P=0.033). Conclusion PIM is related to the adverse outcomes of patients with senile debility. We should strengthen the screening of senile debility and rational drug use in clinical practice.
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