抗胆碱能药物及其对老年人谵妄和死亡率的影响。
Anticholinergic drugs and their effects on delirium and mortality in the elderly.
作者信息
Luukkanen M J, Uusvaara J, Laurila J V, Strandberg T E, Raivio M M, Tilvis R S, Pitkälä K H
机构信息
Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland.
出版信息
Dement Geriatr Cogn Dis Extra. 2011 Jan;1(1):43-50. doi: 10.1159/000322883. Epub 2011 Jan 19.
AIM
To investigate the use of drugs with anticholinergic properties (DAPs) and their associations with delirium and mortality among elderly patients with comorbidities.
METHODS
425 patients (≥70 years of age) in geriatric wards and nursing homes were assessed. The use of DAPs was retrieved from their medical records. Delirium was diagnosed according to the DSM-IV criteria.
RESULTS
Of the 341 patients (80.2%) treated with multiple DAPs (≥2), 92 patients (27.0%) suffered from delirium, whereas 14 of 84 patients (16.7%) without DAP treatment had delirium (p = 0.050). In a logistic regression analysis with age, gender, and Charlson Comorbidity Index as covariates, DAP treatment did not predict delirium (odds ratio 1.67, 95% confidence interval 0.87-3.21). The 2-year mortality was 49.3% (n = 168) in DAP users and 35.7% (n = 30) in non-users, respectively (p = 0.026). In the Cox proportional hazard model adjusted for age, gender, and comorbidity, DAPs did not predict mortality (hazard ratio 1.12, 95% confidence interval 0.75-1.68).
CONCLUSION
The use of DAPs is very frequent among frail inpatients with comorbidities, but their use has no independent prognostic significance.
目的
调查具有抗胆碱能特性的药物（DAPs）的使用情况及其与患有合并症的老年患者谵妄和死亡率的关联。
方法
对老年病房和疗养院的425名患者（≥70岁）进行了评估。从他们的病历中检索DAPs的使用情况。根据DSM-IV标准诊断谵妄。
结果
在341名接受多种DAPs治疗（≥2种）的患者中（80.2%），92名患者（27.0%）患有谵妄，而在84名未接受DAPs治疗的患者中，有14名（16.7%）患有谵妄（p = 0.050）。在以年龄、性别和Charlson合并症指数作为协变量的逻辑回归分析中，DAPs治疗并不能预测谵妄（优势比1.67，95%置信区间0.87-3.21）。DAPs使用者中的2年死亡率分别为49.3%（n = 168），非使用者为35.7%（n = 30）（p = 0.026）。在针对年龄、性别和合并症进行调整的Cox比例风险模型中，DAPs不能预测死亡率（风险比1.12，95%置信区间0.75-1.68）。
结论
在患有合并症的体弱住院患者中，DAPs的使用非常频繁，但其使用没有独立的预后意义。
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