应用STOPP/START标准评价老年慢性阻塞性肺疾病住院患者医嘱
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摘要
目的通过应用STOPP/START标准评价老年慢性阻塞性肺疾病(COPD)住院患者医嘱中的潜在不适当用药,为医院引进先进的合理用药系统和提高医院合理用药水平提供参考。方法回顾性分析2017年7-12月某院呼吸内科老年COPD患者住院医嘱,以2014版STOPP/START标准为评价依据,评价其潜在不适当用药情况。结果纳入206例患者,用STOPP/START标准审查出病例风险多为1项,不适当处方病例数和处方遗漏的接近。STOPP标准发现不适当处方中抗毒蕈碱药物用于慢性前列腺疾病(尿潴留的风险)的病例最多(占37.1%),重复用药及选择性COX-2抑制剂使用的不适当情况分别占11.3%和9.7%;START标准发现处方用药遗漏频度较高的前3位药物为血管紧张素转化酶抑制剂、β受体阻滞剂和他汀类药物,分别占25.7%、19.0%和14.3%。结论某院呼吸内科老年COPD住院患者存在较多不适当用药情况,合理用药水平有待提高;2014版STOPP/START标准评价用于评价老年人合理用药具有积极意义,值得引进到医院合理用药的评价系统。
Objective To evaluate the potentially inappropriate medication(PIM) in the elderly patients with COPD by STOPP/START standard, and to provide reference for importing the system and level of rational medication.Methods Elderly patients with COPD in the Department of Respiratory Medicine from July 2017 to December2017 were collected and 2014 edition STOPP/START criteria were used to analyze and evaluate PIM in these patients. Results Altogether 206 patients were screened by STOPP/START criteria, most of whom had at least1 PIM. The number of potential inappropriate prescriptions was close to potential prescribing omissions(PPOs).According to STOPP criteria, PIM was most frequently found in the antimuscarinic drugs for chronic prostate disease(risk of urinary retention)(37.1%), followed by repeated use of drugs(11.3%) and inappropriate use of selective COX-2 inhibitors(9.7%). According to START criteria, the top 3 most common PPOs were the omissions of angiotensin-converting enzyme inhibitor(ACEI), Beta blocker and statins, accounting for 25.7%, 19.0%, and14.3% of all, respectively. Conclusion PIM exists in the elderly patients with COPD, and rational medication needs to be improved. The 2014 edition STOPP/START criteria help evaluate PIM in the elderly patients.
Objective To evaluate the potentially inappropriate medication(PIM) in the elderly patients with COPD by STOPP/START standard, and to provide reference for importing the system and level of rational medication.Methods Elderly patients with COPD in the Department of Respiratory Medicine from July 2017 to December2017 were collected and 2014 edition STOPP/START criteria were used to analyze and evaluate PIM in these patients. Results Altogether 206 patients were screened by STOPP/START criteria, most of whom had at least1 PIM. The number of potential inappropriate prescriptions was close to potential prescribing omissions(PPOs).According to STOPP criteria, PIM was most frequently found in the antimuscarinic drugs for chronic prostate disease(risk of urinary retention)(37.1%), followed by repeated use of drugs(11.3%) and inappropriate use of selective COX-2 inhibitors(9.7%). According to START criteria, the top 3 most common PPOs were the omissions of angiotensin-converting enzyme inhibitor(ACEI), Beta blocker and statins, accounting for 25.7%, 19.0%, and14.3% of all, respectively. Conclusion PIM exists in the elderly patients with COPD, and rational medication needs to be improved. The 2014 edition STOPP/START criteria help evaluate PIM in the elderly patients.
引文
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[7]GOLD Executive Committee.Global strategy for the diagnosis,management,and prevention of chronic obstructivepulmonary disease:revised 2011[EB/OL].[2016-06-10].http//www.goldcopd.org/uploads/users/files/GOLD_AtA-Glance_2011.pdf.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核与呼吸杂志,2013,36(4):255-264.
[9]Conn HO,Poynard T.Corticosteroids and peptic ulcer:meta-analysis of adverse events during steroid therapy[J].JIntern Med,1994,236(6):619-632.
[10]Piper JM,Ray WA,Daugherty JR,et al.Corticosteroid useand peptic ulcer disease:role of nonsteroidal anti-inflammatory drugs[J].Ann Intern Med,1991,114(9):735-740.
[11]宁光,马志中,王卫庆,等.糖皮质激素类药物临床应用指导原则[J].中华内分泌代谢杂志,2012,28(2):1-32.
[12]Liu D,Ahmet A,Ward L,et al.A practical guide to themonitoring and management of the complications of systemiccorticosteroid therapy[J].Allergy Asthma Clin Immunol,2013,9(1):30.
[13]Munson JC,Wahl PM,Daniel G,et al.Factors associatedwith the initiation of proton pump inhibitors in corticosteroidusers[J].Pharmacoepidemiol Drug Saf,2012,21(4):366-374.
[14]中华医学会感染病学分会,肝脏炎症及其防治专家共识专家委员会.肝脏炎症及其防治专家共识[J].中国实用内科杂志,2014,34(2):152-158.
[2]Delgado SE,Montero EB,Mu?oz GM,et al.Improving drug prescribing in the elderly:a new edition of STOPP/START criteria[J].Rev Esp Geriatr Gerontol,2014,50(2):10015-10019.
[3]陈韵岱.β受体阻滞剂在冠状动脉粥样硬化性心脏病治疗中的应用[J].中华高血压杂志,2013,21(10):922-925.
[4]Li J,Chen YP,Li X,et al.Use of secondary preventivemedications in patients with atherosclerotic disease in urban China:a cross-sectional study of 16 860 patients[J].Chin Med J(Engl),2012,125(24):4361-4367.
[5]张丹,葛蕾,蒋立新,等.中国39家大医院动脉粥样硬化性心脑血管病患者他汀类药物应用现状调查[J].中华心血管病杂志,2011,39(5);397-401.
[6]中华医学会骨质疏松和骨矿盐疾病分会,原发性骨质疏松诊治指南(2017)[J].中华骨质疏松和骨矿盐疾病杂志,2017,10(5),413-443.
[7]GOLD Executive Committee.Global strategy for the diagnosis,management,and prevention of chronic obstructivepulmonary disease:revised 2011[EB/OL].[2016-06-10].http//www.goldcopd.org/uploads/users/files/GOLD_AtA-Glance_2011.pdf.
[8]中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版)[J].中华结核与呼吸杂志,2013,36(4):255-264.
[9]Conn HO,Poynard T.Corticosteroids and peptic ulcer:meta-analysis of adverse events during steroid therapy[J].JIntern Med,1994,236(6):619-632.
[10]Piper JM,Ray WA,Daugherty JR,et al.Corticosteroid useand peptic ulcer disease:role of nonsteroidal anti-inflammatory drugs[J].Ann Intern Med,1991,114(9):735-740.
[11]宁光,马志中,王卫庆,等.糖皮质激素类药物临床应用指导原则[J].中华内分泌代谢杂志,2012,28(2):1-32.
[12]Liu D,Ahmet A,Ward L,et al.A practical guide to themonitoring and management of the complications of systemiccorticosteroid therapy[J].Allergy Asthma Clin Immunol,2013,9(1):30.
[13]Munson JC,Wahl PM,Daniel G,et al.Factors associatedwith the initiation of proton pump inhibitors in corticosteroidusers[J].Pharmacoepidemiol Drug Saf,2012,21(4):366-374.
[14]中华医学会感染病学分会,肝脏炎症及其防治专家共识专家委员会.肝脏炎症及其防治专家共识[J].中国实用内科杂志,2014,34(2):152-158.