【摘要】 目的 对包头医学院第一附属医院老年心力衰竭患者住院期间潜在不适当用药(PIM)的发生率及其影响因素进行分析,并对3种标准评估结果的一致性进行比较。方法 回顾性分析2023年5月到2024年4月包头医学院第一附属医院心血管内科收治的老年心力衰竭患者资料,分别采用《中国老年人潜在不适当用药判断标准(2017年版)》(简称“中国标准”)、《美国老年医学会老年人潜在不适当用药Beers标准2023版》(简称“2023年Beers标准”)和第3版老年人潜在不适当处方筛查工具(screening tool of older people’s prescriptions,STOPP)(简称“第3版STOPP标准”)用于评估患者入院时的PIM,采用Kappa检验评估结果的一致性。结果 共纳入598例患者。参照中国标准,有253例(42.3%)存在PIM,共计350例次;参照2023版Beers标准,有270例(45.2%)存在PIM,共计472例次;参照第3版STOPP标准,179例(29.9%)存在PIM,共计250例次;有110例患者同时符合3种标准。多因素Logistic回归分析结果表明,住院天数、年龄、药品种数、重度肾功能不全[肾小球滤过率(eGFR≤30 mL/(min·1.73 m~2)]是3种标准检出PIM的共同影响因素(P<0.05)。3种标准评估结果两两比较的Kappa值为0.356～0.501,两组一致性一般,一组一致性较差。结论老年心力衰竭患者联合疾病复杂用药种类较多,PIM发生率较高;3种标准评估的PIM存在一定差异。心力衰竭用药治疗住院患者PIM风险高,有必要减少用药种数以降低PIM风险。更多还原

【Abstract】 Objective To determine the incidence of potentially inappropriate medication(PIM) for elderly patients with heart failure upon admission,analyze its influencing factors,and compare the consistency of the assessment with three standards.Methods We retrospectively analyzed data on elderly patients with heart failure admitted to the Department of Cardiology at the First Affiliated Hospital of Baotou Medical College from May 2023 to April 2024.The PIM upon admission was evaluated with the 2017 Criteria for Potentially Inappropriate Medication Use in Elderly Chinese Patients(the Chinese standard),the2023 American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults [the Beers criteria(2023 Edition)],and the 3rd Edition of STOPP [STOPP(the Third Edition)].The consistency of evaluation was assessed by the Kappa test.Results Totally 598 patients were included.According to the Chinese standard,PIM was found in 253 patients(42.3%) totaling 350 cases.According to the Beers criteria(2023 Edition),270 patients(45.2%) received PIM,totaling 472 cases.According to STOPP(the Third Edition),PIM was found in 179 patients(29.9%),totaling 250 cases.There were 110patients who met all the three criteria.Multivariate logistic regression analysis showed that hospitalization days,age,drug type,and severe renal function insufficiency [eGFR≤30 mL/(min·1.73 m~2)] were the common influencing factors for PIM detected by the three criteria(P <0.05).The Kappa value of pairwise comparisons of the results of the three evaluation criteria ranged from 0.356 to 0.501,indicating weak consistency.Conclusion There are many kinds of complex drugs in elderly patients with heart failure,with a high incidence of PIM.Differences exist in PIM identification by the three criteria.It is necessary to reduce the number of medications to reduce the high risk of PIM.更多还原