老年患者药物不良反应危险因素

<正>老年患者药物不良反应(ADR)发生率高,不仅降低其生活质量和增加医疗需求,而且增加死亡率。本研究探讨老年患者ADR危险因素。1对象与方法1.1对象2007年5月1日至2008年2月29日我院老年病科出院患者1 778例,分为老年组(≥60岁)和成年组(18⁵9岁)。老年组312例发生406例次ADR,其中男229例,女83     

抗菌药物不良反应135例分析

抗菌药物种类多、适用范围广、用量大,且临床使用存在一定随意性,故存在潜在的不安全隐患。为解抗菌药物不良反应（ADR）的发生情况．笔者对2003～2005年临床收集上报的135例抗菌药物ADR进行回顾性分析,旨在为合理使用抗菌药物提供参考。资料与方法：自我院2003～2005年收集的ADR报告中,选出由抗菌药物引起的135例。采用回顾性分析的方法,分析ADR与患者性别、年龄,所用药物种类,给药途径的关系及其具体表现、评价和转归。ADR临床表现分型按WHO的ADR分型方法。因果关系评价标准按国家药品不良反应监测中心颁布的方法,分为肯定、很可能、可能、不可能四级。     

老年人药物不良反应390例分析

探讨老年人药物不良反应的发生特点和影响因素。方法采用回顾性统计研究方法,对成都市各市级医院2000-01/2006-06报告的390份老年人药物不良反应（Adverse drug reactions in the elderly,ADRE）监测报告进行统计、分析处理。结果在统计的390份ADRE报表中,抗微生物药物116例,占29.74%,排第1位;单一用药143例,占36.67%,而联合用药247例,占63.33%;占前5位的不良反应分别是皮肤及其附件损害、消化系统反应、心血管系统反应、神经系统反应和泌尿系统反应。结论在对老年人进行用药时应合理使用抗微生物药物,减少不必要的联合用药,并应加强对各易损系统的观察和保护。     

老年患者药物不良反应的临床特点

目的探讨老年人药物不良反应(ADR)特点。方法采用现况调查的方法,应用自制ADR调查表对1 778例患者进行调查。结果两组ADR发生率、潜伏期及临床表现(代谢和营养障碍、心血管系统损害、全身性损害、二重感染、老年病五联症)比较有统计学差异(P<0.05),老年组A型、重度均明显多于成年组(P<0.05);老年组需停药者和需对症治疗者、可以避免者均明显高于成年组(P<0.05),两组ADR转归无统计学差异(P>0.05)。结论老年患者ADR发生率高,临床特征及诊疗等方面有别于成年人,应高度重视。     

老年人药物不良反应分析及对策

随着人们生活及卫生保健的改善，人的平均寿命显著延长，许多疾病也就随着年龄的增大而增长，人老病多，特别是慢性疾病。老年人同时使用多种药物治疗的情况很常见，通常都用3—4种药物，甚至10种以上。这样多种药物同时使用，势必使药物不良反应（ADR）和药物中毒的可能性增加，对老年人的安全和健康构成了很大威胁，随差我国老龄人口不断增加，     

急诊输液患者抗生素药物不良反应原因分析

目的:分析急诊输液患者抗生素药物不良反应原因.方法:本次研究我们随机从近三年(2018年1月-2020年3月)期间于我院进行急诊输液治疗的患者中,随机选择了64例在输液治疗过程中发生抗生素药物不良反应的患者.然后根据随机数字法将入组的患者随机分为两组,分别采用针对性护理干预和常规护理,对两组患者在输液治疗过程中抗生素药...     

老年人药物不良反应分析

由于老年人的生理学及药代动力学随年龄的增大而改变，特别是老年人一般合并有多种疾患，如高血压病、糖尿病、肿瘤等，往往应用的药物品种繁多，使得老年人出现药物不良反应(ADR)的机会增加，甚至因药源性疾病而住院治疗。因此，老年人应合理用药，避免药物不良反应的发生。     

糖尿病患者进行药物治疗时常见的不良反应分析

目的对糖尿病患者进行药物治疗时常见的不良反应进行分析与探讨。方法选取该院2012年1月—2014年1月收治的100例糖尿病患者为研究对象,对药物治疗时出现的不良反应进行回顾性分析。结果 100例患者中不合理用药的为41例(41.00%),联合用药的为59例(59.00%);100例患者中大部分出现了一种以上的不良反应现象,其中最多的不良反应现象是低血糖,有75例(75.00%)患者出现了低血糖现象;对不良反应患者进行治疗后,有92例(92.00%)患者痊愈及好转,8例(8.00%)患者因为不配合治疗和不遵医嘱等原因导致了病情恶化。结论在对糖尿病患者进行药物治疗时需要考虑患者的个人特征和所用药物的品种、用法以及剂量等,合理的选择和服用药物,避免不良反应的发生,该院在对糖尿病患者的病例资料进行分析总结后,也取得了显著的效果。     

老年人药物不良反应及用药原则

老年人由于药物代谢动力学的改变，神经系统、内分泌系统、各种器官功能及代偿等逐渐衰退，机体耐受性降低，对药物的敏感性发生变化，因此发病率也随之上升，药物不良反应发生率增高。据统计表明，50～60岁患者的药物不良反应发生率为14．4％，61～70岁为15．7％，71～81岁为18．3％，80岁以上为24．0％，据国家药品监督管理局不良     

抗糖尿病药物所致临床不良反应分析

目的进一步探析抗糖尿病药物所致临床不良反应,提高临床用药安全。方法选取2011年11月—2013年11月期间,于该院发生50例抗糖尿病药物所致临床不良反应报告进行回顾式分析,整理不良反应发生的性别、年龄、药物种类、涉及器官或系统等进行探讨。结果 50例抗糖尿病药物所导致的临床不良反应中,包括男性30例,女性20例,由多种药物引起,患者主要表现为便秘、咳嗽、呼吸困难等,涉及消化系统、呼吸系统、心血管系统等。结论抗糖尿病药物可能导致多种疾病,医护人员在给药过程中,应根据患者的身体情况进行给药,同时,患者在服药过程中,应谨遵医嘱;针对患者所出现的不良反应,应及时采取治疗措施,确保患者生命安全。     

Incidence of adverse drug reactions in geriatric units of university hospitals

Background:   Adverse drug reactions (ADR) in elderly people are often attributed to functional decline and polypharmacy.
Methods:   In this study, a multi-institutional retrospective survey was undertaken to investigate the current status of ADR in geriatric units of university hospitals. The inpatient databases from 2000 to 2002 for five university hospitals were studied, and a total of 1289 patients were analyzed.
Results:   The incidence of ADR, as determined by attending physicians, was 9.2% on average, but varied from 6.3 to 15.8% among the institutions. Factors significantly related to ADR were the number of diagnoses, the number of geriatric syndromes, the number of prescribed drugs, an increase of two or more drugs during hospitalization, longer hospital stay, emergency admission, depression and apathy.
Conclusion:   These results are mostly consistent with previous reports and provide important information on drug treatment in elderly people.     

Hospitalisation and morbidity due to adverse drug reactions in elderly patients: a single‐centre study

Background

Adverse drug reaction (ADR) is a leading but under‐recognised cause of illness, particularly in frail subjects with multiple comorbidities.

Aim

To investigate the frequency, patterns and outcomes of ADR as a cause of hospitalisation in elderly patients admitted to an internal medicine ward.

Methods

We performed a retrospective observational study including every patient aged over 65 years who was admitted to our department during a 12‐month period. Patients admitted to short‐stay (<24 h) observation unit were excluded.

Results

ADR accounted for 106 of total 1750 recorded admissions, which constituted a proportion of 6.1% (95% confidence interval 5.0–7.3%). The median age of patients was 83.5 (78.0–87.0) years and 56.6% were on polypharmacy. A total of 170 ADR was recorded with 45.3% of subjects experiencing concomitantly more than one ADR from a single molecule. Diuretics were the most commonly imputed molecules (30 events, 17.6%), followed by antithrombotics (25 events, 14.7%) and central nervous system‐active drugs (16 events, 9.4%). Interactions were judged responsible for 39 cases of ADR (36.8%). An unfavourable outcome was observed in about one‐third of patients (37.7%). Among those subjects, 11 (10.4%) died and 29 (27.4%) had residual disability.

Conclusion

ADR are a common cause of hospital admission in elderly patients and are often associated with adverse outcomes. Our data underline the need of appropriate strategies aimed at identifying high‐risk patients and avoiding potentially preventable drug toxicities.     

Epidemiology and prevention of adverse drug reactions in the elderly

Many studies have demonstrated a correlation between increasing age and adverse drug reactions. This increased risk is related to aged-related changes in pharmacokinetics and pharmacodynamics. In addition, chronic illnesses such as congestive heart failure, coronary artery disease and hypertension are more prevalent in the elderly who also have an increased risk of diabetes, arthritis and cancer. Consequently elderly patients are often treated with multiple medications, which may cause drug interactions and adverse drug reactions. Adequate undergraduate training in clinical pharmacology and continued professional development in evidence-based therapeutics will undoubtedly reduce inappropriate prescribing and improve the quality of medications. Good communications between physicians and patients are also critically important in avoidance or prevention of adverse drug reactions in the elderly.     

Adverse drug events as a cause of hospital admission in the elderly

Background: Previous studies of adverse drug events (ADE) as a cause of hospital admission in the elderly have often been limited in their ability to assess fully the impact and potential for prevention because they either did not include all categories of ADE and/or did not assess severity and preventability. Aims: To assess the frequency, severity and preventability of ADE causing emergency medical admissions in the elderly. Methods: Cross‐sectional survey of 219 patients aged 75 years and over who were consecutive unplanned admissions to acute medical units of the Royal Hobart Hospital in an 8‐week period during August and September 1998. Results: Seventy‐three of 240 (30.4%) admissions may have been a result of ADE. Patients admitted because of ADE were taking more drugs than those admitted for other reasons. Most ADE were adverse drug reactions to a single (46%) or multiple drugs (25%). Non‐compliance, omission or cessation of indicated treatment accounted collectively for 26% of admissions. Of all ADE admissions 53.4% were considered definitely preventable. The commonest causative drugs were cardiovascular drugs (48.4%), and the commonest manifestations were falls and postural hypotension (24.1%), heart failure (16.9%) and delirium (14.5%). ADE categories in which a high proportion of admissions was both severe and definitely preventable were non‐compliance and omission of indicated treatment. Conclusions: Adverse drug events are a common preventable cause of unplanned medical admissions in the elderly. Non‐compliance and omission of indicated treatment are causes of ADE‐related admissions that are both preventable and frequently associated with severe ADE. (Intern Med J 2001; 31: 199–205)     

Analyzing adverse drug reaction using statistical and machine learning methods: A systematic review

Background:Adverse drug reactions (ADRs) are unintended negative drug-induced responses. Determining the association between drugs and ADRs is crucial, and several methods have been proposed to demonstrate this association. This systematic review aimed to examine the analytical tools by considering original articles that utilized statistical and machine learning methods for detecting ADRs.Methods:A systematic literature review was conducted based on articles published between 2015 and 2020. The keywords used were statistical, machine learning, and deep learning methods for detecting ADR signals. The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines.Results:We reviewed 72 articles, of which 51 and 21 addressed statistical and machine learning methods, respectively. Electronic medical record (EMR) data were exclusively analyzed using the regression method. For FDA Adverse Event Reporting System (FAERS) data, components of the disproportionality method were preferable. DrugBank was the most used database for machine learning. Other methods accounted for the highest and supervised methods accounted for the second highest.Conclusions:Using the 72 main articles, this review provides guidelines on which databases are frequently utilized and which analysis methods can be connected. For statistical analysis, >90% of the cases were analyzed by disproportionate or regression analysis with each spontaneous reporting system (SRS) data or electronic medical record (EMR) data; for machine learning research, however, there was a strong tendency to analyze various data combinations. Only half of the DrugBank database was occupied, and the k-nearest neighbor method accounted for the greatest proportion.     

中国老年人急性药物性肝损伤879例临床荟萃分析

目的 探讨分析我国老年人急性药物性肝损伤的发病特点及诊治策略.方法 以"药物性肝损"或"药物性肝病"和"老年"为检索词,检索中文数据库,提取符合标准的临床资料进行总结和分析.结果 符合纳入标准的文献14篇,共879例老年急性药物性肝损伤患者,男583例,女296例.主要临床表现依次为消化道症状(45.41%)、黄疸(34.58%)、乏力(25.48%)、纳差(21.84%)等,无症状者占35.04%.临床分型以肝细胞型最为多见(57.40%).有827例患者提供了用药信息,其中以抗生素(18.98%)、中草药(18.26%)、心血管类药物(17.90%)和抗肿瘤药物(11.61%)多见.774例患者提供了预后信息,临床治愈和好转率为89.41%.结论 正确认识和处理老年人急性药物性肝损伤,对改善患者预后,降低病死率具有重要而深远的意义.     

高龄社区获得性肺炎的细菌学及药敏分析

目的 分析高龄社区获得性肺炎的细菌学及药敏情况.方法 选取我院收治的高龄社区获得性肺炎患者210例为实验组,同期收治的高龄医院获得性肺炎患者210例作为对照组,取两组患者的痰标本进行病原菌分离培养,分析致病菌的分布及其耐药性.结果 高龄社区获得性肺炎患者感染的致病菌中主要为肺炎克雷伯氏菌和铜绿假单胞菌,医院获得性肺炎患者感染的病原菌中,革兰阴性菌占37.14%,革兰阳性菌占56.67%,其它病原体占6.19%,且其致病菌耐药性均明显高于高龄社区获得性肺炎,P＜0.05,差异具有统计学意义.结论 高龄社区获得性肺炎患者感染的致病菌主要为革兰阴性菌,且其致病菌耐药性明显低于高龄医院获得性肺炎.     

滥用尼美舒利颗粒致不良反应7例临床分析

目的分析7例滥用尼美舒利颗粒致不良反应的临床资料,防止滥用尼美舒利颗粒提供借鉴。方法对7例因发热家长自购尼美舒利颗粒服用引起不良反应的患儿临床资料进行回顾性分析。结果 7例患儿均有不同程度的消化、神经系统症状,且预后不良,其中1例死亡。结论 1岁以内小儿滥用尼美舒利颗粒可导致严重不良反应和致死风险,应遵医嘱和说明书合理用药。