老年门诊患者抗胆碱能负担及其危险因素评估。
Evaluation of anticholinergic burden in elderly outpatients and the risk factors.
作者信息
Lu Xikui, Huang Hangxing, Huang Yamin, Zhang Lu, Wu Xiangping, Wang Zhenting, Xiao Jian
机构信息
Department of Pharmacy, Xiangya Hospital, Central South University, Changsha 410008.
Department of Pharmacology, School of Pharmacy, Dali University, Dali Yunnan 671000.
出版信息
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2023 Jan 28;48(1):114-122. doi: 10.11817/j.issn.1672-7347.2023.220080.
OBJECTIVES
The use of anticholinergic drugs in the elderly may lead to negative events such as falls, delirium, urinary retention and cognitive decline, and the higher the number of anticholinergic drugs use, the more such negative events occur. This study aims to analyze the risk factors associated with the prescription of total anticholinergic drugs in elderly outpatients and evaluate the rationality of anticholinergic drugs, and to provide a reference for reducing the adverse effects of anticholinergic drugs.
METHODS
A list of drugs with anticholinergic activity based on the Beers criteria was established. The basic information (such as age and gender), clinical diagnosis, and medications of elderly outpatient were extracted from hospital electronic medical records, and the Anticholinergic Cognitive Burden (ACB) Scale was used to calculate the anticholinergic burden for each patient. Logistic regression analysis was used to identify the potential risk factors for the occurrence of problems such as multiple medication and insomnia.
RESULTS
A total of 1 840 prescriptions for elderly patients were reviewed. Of these patients, ACB score was more than or equal to 1 in 648 (35.22%) patients. Number of prescription medication (95% CI: 1.221 to 1.336) and insomnia (95% CI: 3.538 to 6.089) were independent factors affecting ACB scores (both P<0.01). Medications for patients of ACB scores were most commonly treated with the central nervous system drugs (such as alprazolam and eszopiclone) and for the cardiovascular system drugs (such as metoprolol and nifedipine).
CONCLUSIONS
There is a high rate of ACB drugs use in geriatric patients, and the clinical focus should be on multiple medication prescriptions, especially on the central nervous system drugs (such as alprazolam and eszopiclone) and cardiovascular system drugs (such as metoprolol and nifedipine). The prescription review should be emphasized to reduce adverse reactions to anticholinergic drugs in elderly patients.
目的
老年人使用抗胆碱能药物可能导致跌倒、谵妄、尿潴留和认知衰退等不良事件，且使用的抗胆碱能药物数量越多，此类不良事件发生得越多。本研究旨在分析老年门诊患者使用抗胆碱能药物总量的相关危险因素，评估抗胆碱能药物的合理性，为减少抗胆碱能药物的不良反应提供参考。
方法
根据Beers标准制定具有抗胆碱能活性的药物清单。从医院电子病历中提取老年门诊患者的基本信息（如年龄和性别）、临床诊断及用药情况，使用抗胆碱能认知负担（ACB）量表计算每位患者的抗胆碱能负担。采用逻辑回归分析确定多药联用和失眠等问题发生的潜在危险因素。
结果
共审查了1840份老年患者处方。其中，648例（35.22%）患者的ACB评分大于或等于1。处方用药数量（95%CI：1.221至1.336）和失眠（95%CI：3.538至6.089）是影响ACB评分的独立因素（均P<0.01）。ACB评分患者的用药最常见于中枢神经系统药物（如阿普唑仑和艾司佐匹克隆）和心血管系统药物（如美托洛尔和硝苯地平）。
结论
老年患者中ACB药物使用率较高，临床应关注多药联用处方，尤其关注中枢神经系统药物（如阿普唑仑和艾司佐匹克隆）和心血管系统药物（如美托洛尔和硝苯地平）。应强调处方审核，以减少老年患者对抗胆碱能药物的不良反应。
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