Hwang M, Zebracki K, Vogel L C
Department of Research, Shriners Hospitals for Children, Chicago, IL, USA.
Department of Psychology, Shriners Hospitals for Children, Chicago, IL, USA.
Spinal Cord. 2015 Sep;53(9):673-8. doi: 10.1038/sc.2015.62. Epub 2015 Apr 21.
Cross-sectional survey.
To describe the medications taken by individuals who had sustained a spinal cord injury (SCI) in childhood or adolescence (age <19 years) and to report the prevalence of polypharmacy and its association with demographic, injury-related and psychosocial factors.
Community.
Structured interviews of adults with pediatric-onset SCI. Routine medications and secondary health conditions (SHCs) experienced were recorded. Polypharmacy was defined as the concomitant use of five or more different types of medications. Bivariate analyses and multiple regression models were conducted to determine associations between polypharmacy and demographic factors, injury-related factors, number of SHCs and psychosocial outcomes (FIM, SF-12v2 Health Survey, CHART, PHQ-9).
A total of 159 participants (male, 63%; tetraplegia, 59%) with mean age 35.0±6.2 years (range, 26.7-50.9 years) were included. Most common routine medications were muscle relaxants (50.3%), bladder medications (48.5%), bowel agents (41.5%), analgesics (26.4%) and antidepressants (16.9%). Polypharmacy was present in 30.8% (n, 49) and was more prevalent in those with tetraplegia (40.2% vs 17.9%; P=0.003). Participants with polypharmacy were older, had lower FIM, CHART and SF-12v2 scores, and higher PHQ-9 scores. Regression models indicate the total number of SHCs, time since injury and tetraplegia to be significant positive predictors of polypharmacy.
Duration of SCI and SHCs are risk factors for polypharmacy in this population of adults with SCI. Measures should be taken to prevent the occurrence of SHCs throughout adulthood so as to prevent the potentially adverse physiological effects and psychosocial outcomes associated with polypharmacy.
横断面调查。
描述童年或青少年时期（年龄<19岁）脊髓损伤（SCI）患者所服用的药物，并报告多重用药的患病率及其与人口统计学、损伤相关因素和心理社会因素的关联。
社区。
对儿童期起病的脊髓损伤成年患者进行结构化访谈。记录常规用药情况和经历的二级健康状况（SHC）。多重用药定义为同时使用五种或更多不同类型的药物。进行双变量分析和多元回归模型，以确定多重用药与人口统计学因素、损伤相关因素、SHC数量和心理社会结局（FIM、SF-12v2健康调查、CHART、PHQ-9）之间的关联。
共纳入159名参与者（男性，63%；四肢瘫痪，59%），平均年龄35.0±6.2岁（范围26.7-50.9岁）。最常见的常规药物是肌肉松弛剂（50.3%）、膀胱用药（48.5%）、肠道用药（41.5%）、镇痛药（26.4%）和抗抑郁药（16.9%）。多重用药的发生率为30.8%（n=49），在四肢瘫痪患者中更为普遍（40.2%对17.9%；P=0.003）。多重用药的参与者年龄较大，FIM、CHART和SF-12v2评分较低，PHQ-9评分较高。回归模型表明，SHC总数、受伤时间和四肢瘫痪是多重用药的显著正预测因素。
在这一成年脊髓损伤患者群体中，脊髓损伤持续时间和二级健康状况是多重用药的危险因素。应采取措施预防成年期全程二级健康状况的发生，以防止与多重用药相关的潜在不良生理影响和心理社会结局。
