Ray W A, Thapa P B, Gideon P
Department of Preventive Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
J Am Geriatr Soc. 2000 Jun;48(6):682-5. doi: 10.1111/j.1532-5415.2000.tb04729.x.
For nursing home residents who require a benzodiazepine, short-acting agents are recommended, primarily to avoid increased risk of falls and other injuries associated with the long-acting agents. However, much of the data for the clinical outcomes of falls and injuries comes from community-dwelling older people.
To quantify the rate of falls among nursing home residents taking benzodiazepines and how this varies with drug elimination half-life.
Historical cohort study.
A total of 2510 residents of 53 Tennessee nursing homes, classified according to benzodiazepine use on each day of follow-up.
Falls occurring during study follow-up.
After adjustment for differences in resident characteristics, benzodiazepine users had a 44% increased rate of falls (adjusted rate ratio 1.44 [95% confidence interval, 1.33-1.56]). The adjusted rate ratio increased from 1.30 (1.12-1.52) for a dose equivalent to < or = 2 mg of diazepam, to 2.21 (1.89-2.60, P < .001) for a dose of > 8 mg. The rate of falls was greatest in the 7 days after the benzodiazepine was started (rate ratio of 2.96 [2.33-3.75]) but remained elevated (1.30 [1.17-1.44]) after the first 30 days of therapy. Drugs with elimination half-lives of <12, 12-23, and > or = 24 hours had adjusted rate ratios of 1.15 (0.94-1.40), 1.45 (1.33-1.59), and 1.73 (1.40-2.14), respectively. Users of hypnotics with elimination half-lives <12 hours had an increased rate of falls occurring during the night (adjusted rate ratio 2.82 [2.02-3.94]).
Although the risk of falls among nursing home residents receiving short-acting benzodiazepines is less than that for the long-acting agents, these drugs are associated with a materially increased risk of nocturnal falls.
对于需要使用苯二氮䓬类药物的养老院居民，推荐使用短效药物，主要是为了避免因长效药物导致跌倒及其他伤害风险增加。然而，关于跌倒和伤害临床结局的许多数据来自社区居住的老年人。
量化服用苯二氮䓬类药物的养老院居民的跌倒发生率，以及该发生率如何随药物消除半衰期而变化。
历史性队列研究。
田纳西州53家养老院的2510名居民，根据随访期间每日苯二氮䓬类药物使用情况进行分类。
研究随访期间发生的跌倒。
在对居民特征差异进行调整后，苯二氮䓬类药物使用者的跌倒发生率增加了44%（调整后的率比为1.44[95%置信区间，1.33 - 1.56]）。相当于地西泮剂量≤2mg时，调整后的率比为1.30（1.12 - 1.52）；剂量＞8mg时，调整后的率比为2.21（1.89 - 2.60，P＜0.001）。跌倒发生率在开始使用苯二氮䓬类药物后的7天内最高（率比为2.96[2.33 - 3.75]），但在治疗的前30天后仍保持升高（1.30[1.17 - 1.44]）。消除半衰期＜12小时、12 - 23小时和≥24小时的药物，调整后的率比分别为1.15（0.94 - 1.40）、1.45（1.33 - 1.59）和1.73（1.40 - 2.14）。消除半衰期＜12小时的催眠药使用者夜间跌倒发生率增加（调整后的率比为2.82[2.02 - 3.94]）。
虽然接受短效苯二氮䓬类药物治疗的养老院居民跌倒风险低于长效药物使用者，但这些药物仍会显著增加夜间跌倒的风险。
