重视肾功能不全老年患者的临床合理用药  

Clinical medication for elderly patients with renal insufficiency

作　　者：张艳秀[1] 蔡乐[1] 赵佳慧 程庆砾 Zhang Yanxiu;Cai Le;Zhao Jiahui;Cheng Qingli(Department of Pharmacy,Medical Supplies Center of PLA General Hospital,Beijing 100853,China;不详)

机构地区：[1]中国人民解放军总医院医疗保障中心药剂科,北京100853 [2]中国人民解放军总医院第二医学中心肾脏科国家老年疾病临床研究中心

出　　处：《中国临床保健杂志》2021年第5期582-588,共7页Chinese Journal of Clinical Healthcare

摘　　要：随着年龄的增长,人体器官的功能储备趋于减少。老年人共病和合并用药增加,尤其肝肾功能减退,导致药物在机体中的吸收、分布、代谢、排泄发生改变,使老年人容易出现药物不良反应和药物相互作用。当老年人肾脏储备能力明显下降时,对各种肾损伤因素的敏感性增高。在应用各种药物时(尤其主要经肾脏代谢和排泄的药物),要首先估算患者的肾功能状况,即使血肌酐在正常范围内,可能肌酐清除率已经下降,有必要调整给药方案,提高用药安全性。本文对肾功能不全老年患者的用药原则以及临床常用药物的剂量调整等进行综述,以期对临床合理用药提供参考。With advancing age,the functional reserve of many organs tends to decrease.The comorbidity and combined use of drugs in the elderly,especially the liver and kidney dysfunction,lead to changes in the absorption,distribution,metabolism and excretion of the drug in the body,making the elderly prone to adverse drug reactions and drug interactions.When the renal reserve capacity of the elderly is significantly reduced,the sensitivity to various renal injury factors is increased.In the application of various drugs(especially drugs mainly metabolized and excreted by the kidneys),it is necessary to first estimate the renal function of the patient,and even if creatinine is within the normal range,the creatinine clearance rate may have decreased.It is necessary to adjust the dosage regimen to improve the safety of medications.This article will reviewe the principles of drug use and dose adjustment of commonly used drugs in elderly patients with renal insufficiency in order to provide a reference for clinical rational drug use.

关 键 词：肾功能不全 处方不当 共病 老年人 综述 

分 类 号：R47[医药卫生—护理学]