依据Beers标准(2019版)调查某三甲医院老年住院患者潜在不适当用药情况及分析评价

目的：通过对老年住院患者用药的回顾性调查评价，发现存在的潜在不适当用药（potentially inappropriate medication，PIM），为老年住院患者合理用药指导及管理提供依据。方法：依据Beers标准（2019版），对某三甲综合医院2019年10-12月所有年龄≥65岁的老年住院患者PIM情况进行回顾性分析，进一步查阅病例并结合疾病指南共识进行评价。结果：共收集患者6 511例，平均年龄为（74.17±7.24）岁，平均住院天数为（12.86±9.16）d，平均用药种类为（24.59±16.22）种，经χ²检验住院天数及用药品种数与PIM的发生存在相关性，差异有统计学意义（P<0.05）。5 464例（83.92%）患者存在PIM问题，其中排名前5的药物为质子泵抑制剂（proton pump inhibitors，PPIs）、艾司唑仑片、唑吡坦片、地西泮及甲氧氯普胺注射液。在与疾病相关的PIM中，患有痴呆、认知障碍、谵妄；骨折或跌倒病史；心力衰竭疾病的老年人出现潜在不合理用药病例数较多，分别为113例、81例和23例。在老年患者应谨慎使用的药物中，以抗精神病药物抗抑郁类药物为代表的中枢神经系统药物和利尿剂使用例次最多为2 460例次，占总例数的93.64%。在可能的药物相互作用中，类固醇激素和非甾体抗炎药的联用比例最多为185例次。对于肾功能不全的患者，在肾脏病4期及以上的患者中，依诺肝素和螺内酯的使用分别为23例和19例。结论：老年住院患者PIM发生率较高，结合病例分析，存在一定的合理性；仍应采取措施减少PIM用药情况的发生，降低用药风险；如临床实际必须使用，应加强用药监护。

Evaluation of potentially inappropriate medication in hospitalized elderly patients based on Beers criteria(2019 edition)

OBJECTIVE To provide a reference of standard medication for the elderly patients through the investigation and evaluation of potentially inappropriate medication (PIM) in the elderly inpatients.METHODS According to Beers criteria (2019 version), the PIM of all elderly inpatients aged ≥65 years from October to December 2019 in a tertiary care general hospital was retrospectively analyzed, and the cases were further consulted and evaluated in combination with the consensus of disease guidelines.RESULTS A total of 6 511 patients were collected, and the average age was (74.17±7.24) years; the average length of hospital stay was (12.86±9.16) d, and the average types of medication were (24.59±16.22). There was a correlation between the length of hospital stay and the number of varieties of medication and the occurrence of PIM, and the difference had statistical significance (P<0.05). PIM problems were present in 5 464 (83.92%) patients, of which the top five drugs were proton pump inhibitors (proton pump inhibitors, PPIs), estazolam tablets, zolpidem tablets, diazepam, and metoclopramide injection.Of the disease-related PIMs, 113, 81, and 23 had dementia, cognitive impairment, delirium; a history of fracture or fall; and older adults with heart failure disease had more cases of potential irrational drug use. Among the drugs that should be used with caution in elderly patients, the use of central nervous system drugs and diuretics represented by antipsychotic antidepressants was the most 2 460, accounting for 93.64% of the total cases.Among the possible drug interactions, the combination of steroid hormones and non-steroidal anti-inflammatory drugs had the highest proportion of 185.For patients with renal insufficiency, enoxaparin and spironolactone were used in 23 and 19 patients with renal disease stage 4 and above, respectively.CONCLUSION The incidence of PIM in elderly inpatients is high. When combined with case analysis, there is still some rationality; measures should be taken to reduce the occurrence of PIM medication and reduce the risk of medication; if it must be used in clinical practice, medication monitoring should be strengthened.