末期老年住院患者多重用药及药物重整调查

Polypharmacy and medication reconciliation in the hospitalized elderly patients near the end of life

【摘要】目的 分析末期老年住院患者临床特点及用药情况。方法 采用老年人1年内死亡率预测指数评分,入选2015年1月至2017年12月北京协和医院老年医学科病房≥70岁的末期老年患者99例,收集并分析患者慢性病、老年综合征特点、入院带药种数、经药物重整后出院带药种数及患心脑血管疾病的末期老年患者用药情况。应用SPSS 21.0统计软件对数据进行分析。根据数据类型,组间比较采用t检验或McNemar配对χ²检验。结果 99例患者1年内死亡率预测指数7~16(9.8±2.3)分。患者慢性病占比前3位依次为恶性肿瘤(76.8%)、高血压(56.6%)及冠心病(39.4%),前3位老年综合征依次为多重用药(出院带药≥5种,72.7%)、营养不良或营养风险(72.7%)及便秘(45.4%)。入院时患者用药数(4.7±3.7)种,药物重整后出院带药数显著增加,为(7.4±3.9)种,其中维生素、通便药、镇痛药、呼吸系统药、抑酸药、铁剂及抗抑郁药等对症药物的使用率显著增加,对因药物降压药使用率显著降低,差异均有统计学意义(P<0.05)。患有心脑血管疾病的48例患者出院时52.1%(25/48)使用抗血小板药,66.7%(32/48)使用他汀类药物。23例因出血风险较高,或存在活动性出血未使用抗血小板药；16例患者主要因失能、他汀类药物相关不良反应风险高、新发肌痛或新发肝功能异常未使用他汀类药物。结论 末期老年患者经药物重整后对症治疗药物使用率增加,对因药物使用率下降,心血管疾病用药策略需结合患者自身情况合理制定。

基金项目:北京市科委十大疾病科技成果推广(Z171100001017251)；中国医学科学院医学与健康科技创新工程(2017-I2M-1-011)

【Abstract】Objective To analyze the clinical characteristics and medication in the hospitalized elderly patients near the end of life. Methods Based on 1-year mortality prediction index, a total of 99 elderly patients (aged ≥70 years) were enrolled in the study, who were treated in the Department of Geriatrics, Peking Union Medical College Hospital from January 2015 to December 2017. Data were collected and analyzed of the characteristics of chronic diseases, geriatric syndrome, number of medications taken in hospital, number of medications taken out of hospital after medication reconciliation and number of medications taken for cardiovascular and cerebrovascular diseases. SPSS statistics 21.0 was used for data analysis. Depending on data type, Student′s t test or McNemar matching χ² test were performed for comparison. Results One-year mortality index for the 99 patients was 7-16 (9.8±2.3)score. The top three chronic diseases were malignant tumors (76.8%), hypertension (56.6%) and coronary heart disease (39.4%). The top three geriatric syndromes were polypharmacy (≥5 taken out of hospital; 72.7%), malnutrition or nutrition risk (72.7%) and constipa-tion (45.4%). The number of medications after medication reconciliation on discharge (7.4±3.9) increased significantly as compared with those used on admission (4.7±3.7; P<0.05), with increased use of symptomatic drugs such as vitamins, laxatives, analgesics, respiratory system drugs, antiacids, iron supplements and antidepressants and decreased use of antihypertensives (P<0.05). Of 48 patients with cardiovascular and/or cerebrovascular diseases, 25 (52.1%) were taking antiplatelet drugs and 32 (66.7%) were taking statins on discharge; 23 did not take antiplatelet drugs because of high risk of bleeding or active hemorrhage, and 16 did not take statins because of disability, high risk of associated adverse reactions, new myalgia or new abnormal liver function. Conclusion The rate of symptomatic drugs increases after medication reconciliation in the elderly patients near the end of life and strategies for cardiovascular diseases need to be formulated in accordance with the patient′s own condition.