STOPP/START标准2014版在住院老年患者心血管系统用药评价中的应用

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目的回顾性分析本院住院老年患者潜在不适当的心血管系统用药情况,为临床合理用药提供参考。方法收集本院2016年5月年龄≥65岁老年患者住院医嘱,以2014版STOPP/START标准为评价依据进行分析,评价老年患者潜在不适当用药情况。采用Logistic回归方法分析潜在不适当用药的危险因素。结果纳入分析的患者共266例,男性140例(52.6%),女性126例(47.4%),平均年龄(75.3±7.3)岁,疾病诊断数平均为(6.1±3.3),且超过5种者占62.8%;出院带药数平均为(5.0±3.3),其中超过5种者占54.0%。老年患者常见或重要的合并症中排名前3位的依次为高血压、心力衰竭和脑卒中,分别占总样本的58.6%、44.7%和28.9%。通过抗栓标准的综合评价,74.4%的老年患者需要通过物理方法或抗栓药物进行治疗,29.3%的患者未采取任何预防措施。通过STOPP/START标准审查出的病例风险多为1项,用药遗漏情况较用药不适当情况突出,占33%。利用STOPP标准发现非甾体类抗炎药与抗血小板药物联用且未使用质子泵抑制剂的病例最多,占25%,重复用药及噻嗪类利尿药使用的不适当情况分别占21%和17%;利用START标准发现用药遗漏发生率较高的前3位药物为抗血小板药物、血管紧张素转化酶抑制药、他汀类药物,分别占42%、33%、32%;Logistic回归分析结果显示年龄、合并疾病诊断数、外周血管疾病、是否有抗栓治疗指征、是否进行抗凝治疗这5种因素对潜在不适当用药风险有影响。结论 STOPP/START标准在住院老年患者心血管系统用药评价中具有积极意义,但仍有必要制定针对我国老年患者的潜在不适当用药标准。 Objective To retrospectively analyze the potentially inappropriate medication of cardiovascular system in hospitalized elderly patients in our hospital and provide reference for clinical rational drug use. Methods The hospitalization order of elderly patients aged 65 years or older in our hospital in May 2016 was collected and analyzed according to the 2014 STOPP / START standard as the evaluation basis to evaluate the potential inappropriate medication in elderly patients. Logistic regression was used to analyze the risk factors for potentially inappropriate medication. Results A total of 266 patients were enrolled in this study, including 140 males (52.6%), 126 females (47.4%), mean age (75.3 ± 7.3) years and average number of disease diagnoses (6.1 ± 3.3) Accounting for 62.8%. The mean number of discharged patients with medication was (5.0 ± 3.3), of which more than 5 accounted for 54.0%. The top 3 most common or important comorbidities in elderly patients were hypertension, heart failure and stroke, accounting for 58.6%, 44.7% and 28.9% of the total sample, respectively. Through a comprehensive evaluation of antithrombotic criteria, 74.4% of elderly patients need physical therapy or antithrombotic therapy, 29.3% of patients did not take any preventive measures. The case risk that passed the STOPP / START standard was mostly 1 item, and the discrepancy of medication use was more prominent than that of medication use, accounting for 33%. The use of STOPP criteria found that non-steroidal anti-inflammatory drugs and antiplatelet drugs combined with no use of proton pump inhibitors, the largest number of cases, accounting for 25%, repeated use of drugs and inappropriate use of thiazide diuretics accounted for 21% and 17%; using the START standard found that drug abuse missed the higher incidence of the first three drugs for antiplatelet drugs, angiotensin converting enzyme inhibitors, statins, accounting for 42%, 33%, 32%; Logistic regression analysis Five factors, such as age, comorbid disease diagnosis, peripheral vascular disease, antithrombotic indications, and anticoagulant therapy, have an impact on the risk of potentially inappropriate medication. Conclusion The STOPP / START standard has positive significance in the evaluation of cardiovascular system drug use in hospitalized elderly patients. However, it is still necessary to develop a potential inappropriate medication standard for elderly patients in our country.
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