分析危重症患者药物不良事件的危险因素*。
Analysis of risk factors for adverse drug events in critically ill patients*.
机构信息
Department of Pharmacy and Clinical Translational Sciences, University of Pittsburgh, School of Pharmacy, Center for Pharmacoinformatics and Outcomes Research, Pittsburgh, PA, USA.
出版信息
Crit Care Med. 2012 Mar;40(3):823-8. doi: 10.1097/CCM.0b013e318236f473.
OBJECTIVES
An evaluation of risk factors for adverse drug events in critically ill patients has not been previously studied. The purpose of this original study was to determine risk factors for adverse drug events in critically ill adult patients.
DESIGN
This retrospective case-control study includes patients who were admitted to the intensive care unit during a 7.5-yr period.
SETTING
Academic medical center with 647 beds that contains approximately 120 intensive care unit beds.
PATIENTS
Patients in the case group experienced an adverse drug event as documented in the hospital's database. The control group comprised the next two patients admitted to the same intensive care unit by the same admitting service.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Twenty-nine suspected risk factors identified from the literature were evaluated, including patient characteristics, drug characteristics, and laboratory values using a multiple logistic regression. A sample of 1101 cases and controls (54% male), with a mean age of 59.4 ± 17.5 yrs, were identified. In 367 cases, there was a total of 499 documented adverse drug events. Patients with kidney injury, thrombocytopenia, and those admitted emergently were 16-times, 3-times, and 2-times more likely to have an adverse drug event, respectively. Patients who were administered intravenous medications had a 3% higher risk of having an adverse drug event for each drug dispensed. Overall, the case group received more drugs per intensive care unit day and more drugs per intensive care unit stay.
CONCLUSIONS
Several patient and drug-related characteristics contribute to the risk of adverse drug events in critically ill patients. Diligent monitoring of factors that can influence the pharmacokinetic properties for existing drug therapies is necessary. Drug regimens should be evaluated daily for minimization. Based on previous studies, pharmacists as part of the interdisciplinary team could help to manage these risks.
目的
目前尚未对危重症患者药物不良事件的危险因素进行评估。本原始研究旨在确定成年危重症患者药物不良事件的危险因素。
设计
本回顾性病例对照研究纳入了在 7.5 年期间入住重症监护病房的患者。
设置
拥有 647 张床位的学术医疗中心，其中包含约 120 张重症监护病房床位。
患者
在医院数据库中记录有药物不良事件的患者被归入病例组。对照组由同一重症监护病房、同一主治医生收治的下两位患者组成。
干预措施
无。
测量和主要结果
从文献中确定了 29 个可疑危险因素，并使用多项逻辑回归对患者特征、药物特征和实验室值进行了评估。共纳入了 1101 例病例和对照（54%为男性），平均年龄为 59.4±17.5 岁。在 367 例病例中，共有 499 例药物不良事件被记录。有肾脏损伤、血小板减少和急诊入院的患者发生药物不良事件的可能性分别增加 16 倍、3 倍和 2 倍。每使用一种药物，静脉内用药的患者发生药物不良事件的风险就会增加 3%。总体而言，病例组在重症监护病房每住院 1 天使用的药物和在重症监护病房每住院 1 天使用的药物都更多。
结论
一些患者和药物相关的特征会增加危重症患者药物不良事件的风险。需要仔细监测可能影响现有药物治疗药代动力学特性的因素。应每天评估药物治疗方案以尽量减少药物的使用。根据以往的研究，药剂师作为多学科团队的一员，可帮助管理这些风险。
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