發(fā)布時(shí)間：2018-04-18 06:48

  本文選題：Beers標(biāo)準(zhǔn) + 老年患者��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：老年人常常多病共存，導(dǎo)致多重用藥（polypharmacy），很可能存在潛在不恰當(dāng)用藥（potentially inappropriate medication，PIM），潛在不恰當(dāng)用藥可能會(huì)引起藥物不良反應(yīng)（adverse drug reaction，ADR），導(dǎo)致藥物不良事件（adverse drugevents，ADEs）、醫(yī)藥費(fèi)用、住院率和死亡率的增加。本研究應(yīng)用Beers標(biāo)準(zhǔn)(2012年版)對(duì)2013年首次入住我院的439名65歲以上老年患者用藥情況進(jìn)行回顧性分析判斷其潛在不恰當(dāng)用藥，了解我院老年患者用藥情況，探討影響老年患者發(fā)生潛在不恰當(dāng)用藥的可能因素。 方法：選擇2013年1月-2013年12月首次入住大連醫(yī)科大學(xué)附屬第一醫(yī)院干部綜合科的患者，共439例為研究對(duì)象，年齡65-95歲（平均年齡78.58±7.03歲），其中男262例，年齡65-95歲（平均年齡79.56+7.12歲）；女177例，，年齡65-95歲（平均年齡77.12+6.66歲）；患者住院時(shí)間2-30天。排除惡性腫瘤及既往已多次于我院住院的患者。主要以2012年版Beers標(biāo)準(zhǔn)為依據(jù)判斷潛在不恰當(dāng)用藥，Beers標(biāo)準(zhǔn)未包括的與年齡無(wú)關(guān)的潛在不恰當(dāng)用藥通過(guò)查閱藥理學(xué)理論及相關(guān)文獻(xiàn)進(jìn)行判斷。以發(fā)生潛在不恰當(dāng)用藥為因變量，以年齡、性別、臨床診斷、治療藥物、住院天數(shù)、付費(fèi)方式等因素為自變量，進(jìn)行多因素非條件Logistic逐步回歸模型進(jìn)行分析。 結(jié)果：平均聯(lián)合用藥數(shù)為(9.01±4.93)種，最多一人同時(shí)應(yīng)用24種藥物，最少?zèng)]有用藥，＜5種79例（18.00%），聯(lián)合應(yīng)用≥5種藥物達(dá)82%，其中5～10種191例（43.51%），11～20種160例（36.45%），＞20種8例（1.82%），45例（10.25%）應(yīng)用了中藥制劑，如丹參川芎嗪、銀杏葉提取物、參松養(yǎng)心膠囊等。根據(jù)Beers標(biāo)準(zhǔn)，76例（17.31%）發(fā)生了82人次潛在不恰當(dāng)用藥，70人（15.95%）存在1種潛在不恰當(dāng)用藥，6人（1.37%）存在2種潛在不恰當(dāng)用藥，其中74例為與診斷或疾病無(wú)關(guān)的潛在不恰當(dāng)用藥，頻率最高的藥物為阿普唑侖、艾司唑侖、胺碘酮、多沙唑嗪，8例(1.82%)為與疾病狀態(tài)相關(guān)的潛在不恰當(dāng)用藥。66例（15.03%）使用了老年患者需慎用的藥物。Beers標(biāo)準(zhǔn)未包括的其他潛在不恰當(dāng)用藥共23例（5.24%），主要問(wèn)題為藥物間相互作用。Logistic回歸分析顯示用藥數(shù)量，男性進(jìn)入回歸方程，且p＜0.05。 結(jié)論：Beers標(biāo)準(zhǔn)在評(píng)估老年住院患者是否存在潛在用藥風(fēng)險(xiǎn)有重要的應(yīng)用價(jià)值，但它并不能代替臨床醫(yī)師的專(zhuān)業(yè)判斷，多因素影響老年住院患者發(fā)生潛在不恰當(dāng)用藥，臨床醫(yī)師應(yīng)控制這些因素，減少藥物相關(guān)性問(wèn)題發(fā)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 鹵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 鹵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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