Beers标准、STOPP/START标准及中国PIM初级判断标准评价某院心血管内科医嘱的对比研究  

Comparison of the Beers criteria,STOPP/START criteria and Chinese potentially inappropriate medication primary judgment criteria in evaluating prescription orders in cardiovascular department

作　　者：何梅[1,2] 邵鑫 赵曜[1] 李胜前[1] 张晓钰[3] HE Mei;SHAO Kin;ZHAO Yao;LI Sheng-qian;ZHANG Xiao-yu(Department of Pharmacy, The Af filiated Hospital of North Sichan Medical College, Sicuan Nanchong 637000, China;School of Pharmacy, North Sichan Med ical College, Sicuan Nanchong 637000, China;Baoji Central Hospital, Shaanxi Baoji 721008, China)

机构地区：[1]川北医学院附属医院,四川南充637000 [2]川北医学院药学院,四川南充637000 [3]宝鸡市中心医院,陕西宝鸡721008

出　　处：《中国医院药学杂志》2018年第7期781-784,791,共5页Chinese Journal of Hospital Pharmacy

基　　金：全国医药经济信息网科技传播创新工程2017年重点项目(编号:CMEI2017KP00702)

摘　　要：目的:比较2015年版Beers标准,2014年版STOPP/START标准及中国潜在不合理用药(PIM)初级判断标准的异同,为完善中国标准提供参考。方法:回顾性分析2017年1-3月于某三甲综合医院心血管内科住院的老年患者医嘱,以前述3个标准为评价依据进行对比分析,用SPSS13.0进行数据统计分析。结果:纳入患者417例依照中国PIM初级判断标准,审查出潜在不适当用药有184例(44.1%),且列出了药物风险点;依照Beers标准,除潜在不适当用药230例(55.2%)外,还审查出应谨慎使用药物225例(54.0%),非抗感染药物间相互作用6例(0.2%)及因肾功不全使用非抗感染药物的警示病例60例(14.4%)三部分内容,且每个推荐条目都注明相应的证据分级和推荐强度。STOPP/START标准按生理系统分类,除潜在不适当用药195例(46.8%)外,还审查出处方遗漏97例(23.3%)。3个标准均未涉及评价中成药。结论:三个标准在适用对象及关注点上相似,但在编排及内容上有区别,在潜在不合理用药的评判中中国标准缺乏药物相互作用、重复用药及中成药潜在不适当用药条目。此外,中国标准亦缺乏Beers标准的谨慎使用药物及STOPP/START标准的处方遗漏医嘱。同时,该院心血管内科老年住院患者不适当用药情况较严重且用药品种偏多,合理用药水平还有待提高。OBJECTIVE To compare the 2015 Beers criteria,2014 STOPP/START criteria and Chinese PIM primary judgment criteria and help produce the Chinese criteria. METHODS Elder inpatients stayed in department of cardiovascular diseases in the first quarter of 2017 were retrospectively collected and evaluated according to the above three criteria. SPSS 13. 0 was used for statistical analysis. RESULTS Totally 417 patients were included,184 cases（ 44. 1 %） of potential inappropriate drugs were found and the risk points were listed according to Chinese PIM primary judgment criteria. According to the Beers criteria,there were 230 cases of potential inappropriate medication（ 55. 2 %）,225 cases（ 54. 0 %） of cautious medication,6 cases of drug interactions between non antibiotics（ 0. 2 %）,60 cases（ 14. 4 %） of warning patients receiving antibiotics in patients with renal insufficiency. Corresponding evidence level and recommendation intensity were also noted. According to the STOPP/START criteria by physiological systems,there were 97 cases（ 23. 3 %） of prescription omission and 195 cases（ 46. 8 %） of potential inappropriate medication. None of the three criteria involved in proprietary Chinese medicines. CONCLUSION The three criteria are similar at the applicable object and point of view,but different in contents. Assessments of drug interactions,repeated medication and proprietary Chinese medicine potential inappropriate drug use are not available for Chinese PIM primary judgment criteria. Prescription omission in Beers criteria and the cautious medication in the STOPP/START are lacked in Chinese criteria. Inappropriate medication is severe in inpatients in the department of cardiovascular diseases,there are too many drug varieties,and the level of rational medication needs to be improved.

关 键 词：Beers标准 STOPP/START标准 中国PIM初级判断标准 老年患者 潜在不合理用药 

分 类 号：R969[医药卫生—药理学]