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1.中国科学院合肥肿瘤医院药学中心,合肥 230031
2.中国科学院合肥肿瘤医院胃肠外科,合肥 230031
Published:30 March 2023,
Received:19 July 2022,
Revised:02 February 2023,
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王君萍,黄玲玲,朱文靖等.老年肿瘤患者潜在不适当用药的影响因素分析 Δ[J].中国药房,2023,34(06):740-745.
WANG Junping,HUANG Lingling,ZHU Wenjing,et al.Analysis of influential factors for potentially inappropriate medication in elderly cancer patients[J].ZHONGGUO YAOFANG,2023,34(06):740-745.
王君萍,黄玲玲,朱文靖等.老年肿瘤患者潜在不适当用药的影响因素分析 Δ[J].中国药房,2023,34(06):740-745. DOI: 10.6039/j.issn.1001-0408.2023.06.19.
WANG Junping,HUANG Lingling,ZHU Wenjing,et al.Analysis of influential factors for potentially inappropriate medication in elderly cancer patients[J].ZHONGGUO YAOFANG,2023,34(06):740-745. DOI: 10.6039/j.issn.1001-0408.2023.06.19.
目的
2
分析老年肿瘤患者潜在不适当用药(PIM)的影响因素。
方法
2
收集某院2021年1-12月住院治疗的老年肿瘤患者资料,采用2019年美国老年医学会的Beers标准(以下简称“2019版Beers标准”)和《中国老年人潜在不适当用药判断标准(2017年版)》(以下简称“中国PIM标准”)对患者的PIM进行分析,采用多因素Logistic回归分析PIM的影响因素。
结果
2
共纳入293例患者。参照2019版Beers标准,有211例患者(72.01%)存在PIM,其中204例(69.62%)存在与药物相关的PIM,6例(2.05%)存在与疾病或症状有关的PIM,46例(15.70%)存在应谨慎使用药物的PIM,32例(10.92%)存在应避免的药物-药物相互作用的PIM,11例(3.75%)存在基于肾功能的PIM;发生例次居前5位的药物分别为质子泵抑制剂、甲氧氯普胺、异丙嗪等第1代抗组胺药、布洛芬等止痛药物、甲地孕酮。参照中国PIM标准,有132例患者(45.05%)存在PIM;119例(40.61%)存在与药物相关的PIM,涉及25种药物,其中高风险药物7种、低风险药物18种;24例(8.19%)存在疾病状态下PIM;发生例次居前4位的药物分别为异丙嗪、甲地孕酮、布洛芬和西咪替丁。多因素Logistic回归分析结果显示,与住院时间≤10 d比较,住院时间11~30 d的患者发生PIM的风险较高[优势比(OR)=8.836 8,95%置信区间(CI)(3.217 8,31.940 9),
P
=0.000 1];与临床疾病诊断≤5种比较,临床疾病诊断≥11种的患者发生PIM的风险较高[OR=10.930 1,95%CI(3.000 9,70.922 9),
P=
0.001 8];与手术治疗比较,接受抗瘤药物治疗的患者发生PIM的风险较高[OR=2.209 5,95%CI(1.180 2,4.176 9),
P=
0.013 6]。
结论
2
老年肿瘤患者合并多种疾病,用药复杂,PIM发生率较高;住院时间(11~30 d)、临床疾病诊断数(≥11种)、抗肿瘤药物治疗是其发生PIM的主要影响因素。
OBJECTIVE
2
To analyze the influential factors for potentially inappropriate medication (PIM) in elderly cancer patients.
METHODS
2
The data of elderly cancer patients hospitalized in a hospital from January to December 2021 were collected. According to the Beers standard of the American Geriatrics Society in 2019 (hereinafter referred to as the “2019 version of Beers standard”) and
Criteria for Potentially Inappropriate Drug Use in Chinese Elderly
(2017 version) (hereinafter referred to as the “Chinese PIM standard”), the PIM status of elderly cancer patients was retrospectively analyzed. Multivariate Logistic regression analysis was used to identify influential factors for PIM.
RESULTS
2
A total of 293 patients were included in the study. According to the 2019 version of Beers standard, 211 patients (72.01%) had PIM, of which 204 (69.62%) had PIM related to drugs, 6 (2.05%) had PIM related to diseases or symptoms, 46 (15.70%) had PIM that should be used with caution, 32 (10.92%) had PIM with drug-drug interaction that should be avoided, and 11 (3.75%) had PIM based on renal function; the top 5 drugs in the list of incidence were proton pump inhibitors, metoclopramide, the first-generation antihistamines as promethazine, analgesics as ibuprofen and megestrol. According to the Chinese PIM standard, there were 132 patients (45.05%) with PIM, of which 119 (40.61%) had PIM related to drugs, involving 25 drugs (included 7 high-risk drugs and 18 low-risk drugs), and 24 (8.19%) with PIM in disease status; top 4 drugs in the list of incidence were promethazine, megestrol, ibuprofen and cimetidine. Multivariate Logistic regression analysis showed that compared with patients with hospital stay≤10 days, patients with hospital stay between 11 and 30 days had a higher risk of PIM [odds ratio (OR)=8.836 8, 95% confidence interval (CI) (3.217 8, 31.940 9),
P
=0.000 1]; compared with the patients with the number of clinical disease diagnosed≤5, patients with the number of clinical disease diagnosed≥11 had a higher risk of PIM [OR=10.930 1, 95%CI (3.000 9, 70.922 9),
P
=0.001 8]; compared with surgical treatment, patients receiving antineoplastic drugs had a higher risk of PIM [OR=2.209 5, 95%CI (1.180 2, 4.176 9),
P
=0.013 6].
CONCLUSIONS
2
Elderly cancer patients have multiple diseases, complicated medication, and a high incidence of PIM. The length of hospital stay (11-30 d), the number of clinical disease diagnosed (≥11) and anti-tumor drugs are main influential factors for PIM in patients.
老年肿瘤患者潜在不适当用药影响因素用药安全
potentially inappropriate medicationinfluential factorssafety of drug use
ZHENG R S,ZHANG S W,ZENG H M,et al.Cancer incidence and mortality in China,2016[J]. J Natl Cancer Cent,2022,2(1):1-9.
樊鹏利,刘银萍,洪雪姣,等. 2种标准评估老年慢性阻塞性肺疾病住院患者潜在不适当用药[J]. 中国合理用药探索,2022,19(3):71-77.
曹毛毛,陈万青. 中国恶性肿瘤流行情况及防控现状[J]. 中国肿瘤临床,2019,46(3):145-149.
BARÉ M,HERRANZ S,JORDANA R,et al. Multimorbidity patterns in chronic older patients,potentially inappropriate prescribing and adverse drug reactions:protocol of the multicentre prospective cohort study MoPIM[J]. BMJ Open,2020,10(1):e033322.
By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2019 updated AGS Beers criteria® for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc,2019,67(4):674-694.
中国老年保健医学研究会老年合理用药分会,中华医学会老年医学分会,中国药学会老年药学专业委员会,等. 中国老年人潜在不适当用药判断标准:2017年版[J]. 药物不良反应杂志,2018,20(1):2-8.
舒冰,方玉婷,李民,等. 老年多重用药患者潜在不适当用药情况及其影响因素研究[J]. 中国全科医学,2021,24(17):2134-2139,2147.
李燕华,李翠红,丁莉,等. 基于2019年版Beers标准评价老年住院患者潜在不适当用药的价值[J]. 中华老年多器官疾病杂志,2021,20(8):567-571.
陈露露,王亚芹,欧阳冬生. 化疗止吐药物的研究进展[J]. 肿瘤药学,2014,4(2):107-111.
中国药学会医院药学专业委员会,中华医学会临床药学分会,《质子泵抑制剂优化应用专家共识》写作组. 质子泵抑制剂优化应用专家共识[J]. 中国医院药学杂志,2020,40(21):2195-2213.
杨妤,龙斌,李树梁,等. 低剂量吗啡与曲马多治疗中度癌痛的效果比较[J]. 广东医学,2019,40(15):2168-2172.
丁永永. 盐酸羟考酮缓释片弱化二阶梯治疗中度癌痛的效果及安全性分析[J]. 中华肿瘤防治杂志,2020,27(增刊1):170-171.
LEO M,SCHMITT L I,ERKEL M,et al. Cisplatin-induced neuropathic pain is mediated by upregulation of N-type voltage-gated calcium channels in dorsal root gang-lion neurons[J]. Exp Neurol,2017,288:62-74.
黎嘉雅,凌地洋,王哲银. 普瑞巴林联合羟考酮治疗癌性神经病理性疼痛的临床效果[J]. 临床合理用药杂志,2022,15(10):91-93.
何丹,吴晓燕,董娜,等. 基于2019年版Beers标准分析评价某院老年住院患者潜在不适当用药[J]. 中国医院药学杂志,2019,39(19):1993-1999.
廖世莉,田方圆,张莹,等. 2018年成都9家医院老年科住院患者潜在不适当用药与相关风险因素分析[J]. 药物流行病学杂志,2021,30(4):245-250,259.
梁致如,曹剑,王蓉,等. 高龄住院患者潜在不适当用药调查及影响因素分析[J]. 中华老年多器官疾病杂志,2021,20(6):434-438.
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