多重用药对老年冠心病合并心房颤动患者远期预后的影响  

Effects of Polypharmacy on Long-term Prognosis of Elderly Patients with Coronary Heart Disease and Atrial Fibrillation

作　　者：董敏[1] 邹彤[1] 徐蕾[2] 何清华[3] 裴作为 汪芳[1] DONG Min;ZOU Tong;XU Lei;HE Qinghua;PEI Zuowei;WANG Fang(Department of Cardiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing100730,China;Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing100730,China;Department of Endocrinology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing100730,China)

机构地区：[1]北京医院心内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院神经内科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]北京医院内分泌科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730

出　　处：《中国药物警戒》2021年第2期126-132,共7页Chinese Journal of Pharmacovigilance

基　　金：十三五国家科技重大新药创制专项课题(2017ZX09304026);首都卫生发展科研专项(重点)(首发2016-1-4051)。

摘　　要：目的探讨多重用药对老年冠心病合并心房颤动患者远期预后的影响。方法选取2013年1月1日至2015年3月31日期间本院收治的65岁及以上冠心病合并房颤患者,并进行回顾性病例调查,结合电话、门诊及住院病例查询等方式随访至少5年,评价不同用药种类的患者出现肝肾功能变化、药品不良反应(ADR)及主要不良心脑血管事件(MACCE)的差异。结果共295例患者纳入本研究,平均年龄(79.2±5.9)岁,80岁以上高龄老年患者141例(47.8%)。平均患病种类(6.5±1.9)种,平均用药种类(8.3±3.2)种,用药在5种以上患者共267例(90.5%),采取抗血小板治疗者223例(75.6%),抗凝治疗63例(21.4%)。在不同年龄段患者中,根据患者用药种类分为多重用药A组(用药≥8种)和多重用药B组(用药<8种)。低龄老年组(年龄<80岁)中,A组患者合并陈旧性心肌梗死和心力衰竭的比例较B组更高(分别为36.0%比21.5%,52.0%比31.6%,P<0.05)。高龄老年组(年龄≥80岁)中,A组患者NYHA心功能分级较B组更差(2.2±0.9比2.1±1.0,P<0.05)。在长达至少5年的随访中,无论哪个年龄组的老年患者,A组患者的MACCE和心力衰竭发生率显著高于B组(P<0.05),出血发生率略高于B组(P>0.05),但A、B组患者的谷丙转氨酶(ALT)、谷草转氨酶(AST)、肾小球滤过率(GFR)的变化、ADR及死亡率的差异没有统计学意义(P>0.05)。结论多重用药在老年冠心病合并房颤患者中非常普遍,尤其是在合并陈旧性心肌梗死和心力衰竭的患者中比例更高。随访中,除了出血风险略高于其他人群,尚未发现多重用药导致的肝肾功能恶化、其他ADR和死亡率增加。因此,在诊治这类心血管高危人群时,应当给予全面优化的药物治疗方案,在保证疗效的前提下精简治疗方案,争取最佳预后。Objective To explore the effect of polypharmacy on the long-term prognosis of elderly patients with coronary heart disease and atrial fibrillation.Methods Patients aged over 65 years with coronary heart disease and atrial fibrillation were studied and followed up for a minimum of 5 years via the telephone,outpatient and inpatient case inquiry.The difference in liver and kidney function,adverse drug reactions(ADR)and major adverse cardiovascular and cerebrovascular events(MACCE)in patients using different types of drugs was studied.Results A total of 295 patients were included in the study,with an average age of(79.2±5.9)years.In addition,141(47.8%)of these patients were over 80 years old.Each of them was afflicted with(6.5±1.9)kinds of diseases and used(8.3±3.2)types of dispensed drugs on average.267 of these patients(90.5%)were treated with more than 5 types of dispensed drugs,223(75.6%)with antiplatelet therapy and 63(21.4%)with anticoagulation.In different age groups,patients were divided into polypharmacy group A(dispensed drugs≥8)and polypharmacy group B(dispensed drugs<8)according to the types of medication.In the younger group(aged<80 years),the proportion of old myocardial infarction and heart failure in group A was higher than that in group B(36.0%vs 21.5%,52.0%vs 31.6%,respectively,P<0.05).In the older group(aged≥80 years),NYHA heart function grade in group A was worse than that of group B(2.2±0.9 vs 2.1±1.0,P<0.05).During the follow-up of at least 5 years,the incidence of MACCE and heart failure in group A was significantly higher than that in group B in both age groups(P<0.05),and the incidence of bleeding was slightly higher in group A(P>0.05),but there was no significant difference between the two groups in the changes of ALT,AST,GFR,ADR or death rate(P>0.05).Conclusion Polypharmacy is not uncommon in elderly patients with coronary heart disease and atrial fibrillation,especially in patients with old myocardial infarction and heart failure.During the follow-up,no deterioration of liver and

关 键 词：老年人 老年共病 多重用药 冠心病 心房颤动 不良心脑血管事件 

分 类 号：R969.3[医药卫生—药理学]