基于STOPP标准的神经内科门诊老年患者潜在不适当用药分析

Potentially Inappropriate Medication Assessed by STOPP Criteria in Older Neurology Outpatients

关键词:  潜在不适当用药  老年人潜在不适当处方筛查工具  神经内科门诊

Key words:  potentially inappropriate medication  Screening Tool of Older Persons' Prescriptions(STOPP)  neurology outpatients

摘要:

目的 采用老年人潜在不适当处方筛查工具（Screening Tool of Older Persons'Prescriptions，STOPP）标准评估老年神经内科门诊患者的潜在不适当用药（potentially inappropriate medication，PIM）情况。方法 回顾性分析2016年1月-3月就诊于浙江大学医学院附属第二医院神经内科门诊的5 185例年龄≥ 65岁的老年患者，采用STOPP标准评估这些患者用药PIM的发生率。采用多因素Logistic回归分析寻找PIM的危险因素。结果 基于STOPP标准发现，5 185例老年患者中，有290例（5.59%）患者存在至少1次PIM，共发生了446例PIM。其中，发生最普遍的前3位分别是①长期（>1月）使用长效苯二氮䓬类药物和有长效代谢产物的苯二氮䓬类药物；②阿司匹林用于没有冠状动脉、脑及周围血管栓塞病史的患者，或者用于消化性溃疡史患者不加用H2受体阻断剂或PPI，或者阿司匹林剂量≥ 150 mg·d^-1，或者治疗不是脑血管疾病导致的头晕；③长期（>1月）使用抗神经病药物作为催眠药物或者用于帕金森病患者。通过多因素逻辑回归分析发现，患者用药数（OR=1.145，95%CI：1.109~1.182）以及诊断数（OR=1.208，95%CI：1.111~1.313）与PIM发生率显著相关。结论 神经内科门诊老年患者PIM的发生与他们使用的药品数以及诊断数是显著相关的，对于用药品种多，诊断多的患者需要重点关注。

Abstract:

OBJECTIVE To assess the prevalence of using potentially inappropriate medication(PIM) in older neurology outpatients using the Screening Tool of Older Persons' Prescriptions(STOPP) criteria. METHODS A retrospective survey was adapted to include 5 185 neurology outpatients aged ≥ 65 years from Second Affiliated Hospital, Zhejiang University, School of Medicine, from January 2016 to March 2016. PIM were defined using the STOPP criteria. A multivariate logistic regression study was used to identify the risk factors for PIM. RESULTS Based on STOPP criteria, 446 PIM were found to affect 290 patients. Of the 5 185 participants, 290(5.59%) were prescribed at least one PIM. The three most common prescribed PIM were as follows:① long-acting benzodiazepines; ② aspirin with a history of peptic ulcer disease without a histamine H2 receptor antagonist or proton pump inhibitor; ③ long-term neuroleptics in Parkinson Disease patients. Based on multivariate logistic regression analysis, the number of prescription medications (OR=1.145; 95%CI:1.109-1.182) and the number of diagnoses (OR=1.208; 95%CI:1.111-1.313) were significantly associated with PIM. CONCLUSION The numbers of medications and diagnoses were closely associated with PIM in older neurology outpatients. More attention should be paid to elderly patients with multiple medications and diagnoses.