在老年患者中精简神经系统用药疗效与安全性的系统评价与Meta分析  

The efficacy and safety of nervous system drugs deprescribing in older adults:a systematic review and meta analysis

作　　者：贾博颖 周双[2] 张晓琳[3] 周颖[1,2] 崔一民[1,2] 刘新民[3] JIA Bo-ying;ZHOU Shuang;ZHANG Xiao-lin;ZHOU Ying;CUI Yi-min;LIU Xin-min(Department of Pharmaceutical Administration and Clinical Pharmacy,School of Pharmaceutical Science,Peking University,Beijing 100191,China;Department of Pharmacy,Peking University First Hospital,Beijing 100034,China;Departmentof Geriatrics,Peking University First Hospital,Beijing 100034,China;Department of Pharmacy,the First Hospital of TsinghuaUniversity,Beijing 100016,China)

机构地区：[1]北京大学药学院药事管理与临床药学系,北京100191 [2]北京大学第一医院药剂科,北京100034 [3]北京大学第一医院老年内科,北京100034 [4]清华大学第一附属医院药学部,北京100016

出　　处：《中国医院药学杂志》2020年第1期78-83,共6页Chinese Journal of Hospital Pharmacy

摘　　要：目的:评价神经系统用药处方精简在老年患者中的疗效与安全性。方法:采用Cochrane系统评价方法,以"神经类药物"、"处方精简"和"老年患者"为检索词,检索Cochrane Library、PubMed、EbscoHost、MEDLINE、Scopus、Web of Science、EMBASE and ProQuest数据库,对符合纳入标准的随机对照试验(RCT)进行质量评价并按设计要求提取有效信息并进行Meta分析。结果:研究共纳入20项RCT,共纳入患者3 509例,质量为高、中、低者分别为6、5、9篇。Meta分析结果显示:针对神经类药物的处方精简可以降低跌倒发生率(OR 0.45, 95%CI 0.28~0.74,P=0.002),对死亡率(OR 0.82, 95%CI 0.44~1.53,P=0.53)、住院率(OR 0.42, 95%CI 0.14~1.28,P=0.13)及不良反应(OR 1.18, 95%CI 0.89~1.57,P=0.24)影响差异无统计学意义。亚组分析显示,神经类药物的处方精简明显降低了65岁至79岁患者跌倒风险(OR 0.44, 95%CI 0.27~0.74,P=0.002),有效降低了认知功能正常患者的跌倒风险(OR 0.07, 95%CI 0.02~0.21,P<0.000 01),采用直接精简神经类药物的干预方式能够有效降低患者的跌倒风险(OR 0.16, 95%CI 0.07~0.37,P<0.000 1)。结论:神经类药物的处方精简在老年患者中应用可以减少跌倒发生率。OBJECTIVE To evaluate the efficacy and safety of nervous system medication deprescribing in elderly patients.METHODS The Cochrane Library, PubMed, EbscoHost, MEDLINE, Scopus, Web of Science, EMBASE and ProQuest databases were searched using the Cochrane systematic review method using "neurological drugs", "deprescribing" and "elderly patients" as search terms to evaluate the quality of randomized controlled trials(RCTs) that met the inclusion criteria and to extract valid information and perform meta-analysis according to the design requirements.RESULTS A total of 20 RCTs with a total of 3509 patients were included in the study, with 6, 5, and 9 articles of high, medium, and low quality, respectively. Meta-analysis showed that neuroleptic deprescribing reduced the incidence of falls(OR 0.45, 95% CI 0.28-0.74, P=0.002), but had no significant effect on mortality(OR 0.82, 95% CI 0.44-1.53, P=0.53), hospitalization(OR 0.42, 95% CI 0.14-1.28, P=0.13), or adverse events(OR 1.18, 95% CI 0.89-1.57, P=0.24).Subgroup analyses showed that neuroleptic deprescribing significantly reduced the risk of falls in patients aged 65 to 79 years(OR 0.44, 95% CI 0.27-0.74, P=0.002), effectively reduced the risk of falls in cognitively normal patients(OR 0.07, 95% CI 0.02-0.21, P<0.000 01), and effectively reduced the risk of falls in patients treated with direct neuroleptic intervention(OR 0.16, 95% CI 0.07-0.37, P<0.000 1).CONCLUSION Deprescribing of neuroleptics in elderly patients can reduce the incidence of falls.

关 键 词：处方精简 老年患者 神经系统用药 META分析 

分 类 号：R971[医药卫生—药品]