3种标准评估老年股骨颈骨折患者潜在不适当用药的比较  

Comparison of 3 evaluation criteria for potentially inappropriate medications in elderly patients with femoral neck fracture

作　　者：张晅 孙钰[2] 高扬 江依柔 朱华 宫伟[4] ZHANG Xuan;SUN Yu;GAO Yang;JIANG Yirou;ZHU Hua;GONG Wei(Dept.of Pharmacy,Northern Jiangsu People’s Hospital/Clinical Medial School,Yangzhou University,Jiangsu Yangzhou 225001,China;Dept.of Orthopedics,Northern Jiangsu People’s Hospital,Jiangsu Yangzhou 225001,China;School of Pharmacy,Hubei University of Science and Technology,Hubei Xianning 437100,China;Dept.of Anesthesiology,Northern Jiangsu People’s Hospital,Jiangsu Yangzhou 225001,China)

机构地区：[1]江苏省苏北人民医院/扬州大学临床医学院药学部,江苏扬州225001 [2]江苏省苏北人民医院骨科,江苏扬州225001 [3]湖北科技学院药学院,湖北咸宁437100 [4]江苏省苏北人民医院麻醉科,江苏扬州225001

出　　处：《中国药房》2024年第6期762-766,共5页China Pharmacy

基　　金：江苏省基础研究计划(自然科学基金)项目(No.BK20201221);江苏省药学会-恒瑞医院药学基金科研项目(No.H202134)。

摘　　要：目的分析老年股骨颈骨折患者入院时潜在不适当用药(PIM)的发生情况,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2022年7月到2023年6月江苏省苏北人民医院骨科收治的老年股骨颈骨折患者资料,分别采用《中国老年人潜在不适当用药判断标准(2017年版)》(以下简称“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》(以下简称“2023年Beers标准”)和第3版老年人潜在不适当处方筛查工具(以下简称“第3版STOPP标准”)对患者入院时的PIM进行评估,采用Kappa检验评估结果的一致性。结果共纳入246例患者。参照中国标准,共有49例(19.92%)存在PIM,共计77例次;参照2023版Beers标准,共有64例(26.02%)存在PIM,共计118例次;参照第3版STOPP标准,共有41例(16.67%)存在PIM,共计67例次;有22例患者同时符合3种标准。3种标准评估结果两两比较的Kappa值为0.417~0.486,一致性一般。结论3种标准评估的PIM存在一定差异,但总体发生率均在30%以下;苯二氮类药物、抗精神病药、抗抑郁药等可能会增加患者再次跌倒的风险。OBJECTIVE To analyze the prevalence of potentially inappropriate medication(PIM)in elderly patients with femoral neck fractures at admission and compare the concordance of 3 evaluation criteria.METHODS A retrospective study was conducted to review the data of elderly patients with femoral neck fractures admitted to the Department of Orthopedics in Northern Jiangsu People’s Hospital from July 2022 to June 2023.The PIMs were identified according to the Criteria of Potentially Inappropriate Medications for Older Adults in China:2017edition(hereinafter referred to as Chinese criteria),American Geriatrics Society 2023 Updated AGS Beers Criteria®for Potentially Inappropriate Medication in Older Adults(hereinafter referred to as 2023 Beers criteria),third version criteria for screening tool of older people’s prescriptions for potentially inappropriate medication(hereinafter referred to as STOPP criteria version 3).The concordance of the 3 evaluation criteria was compared by using Kappa statistics.RESULTS A total of 246 patients were included in this study;49 patients(19.92%)with 77 PIMs were detected by the Chinese criteria,64 patients(26.02%)with 118 PIMs were detected by the 2023 Beers criteria,and 41 patients(16.67%)with 67 PIMs were detected by the STOPP criteria version 3;22 patients met all three criteria simultaneously.The concordance among the three criteria showed moderate agreement(0.417≤Kappa≤0.486)when compared in pairs.CONCLUSIONS There are certain differences in the PIM evaluated by the three criteria,but the prevalence of PIMs is below 30%according to the different criteria.Benzodiazepines,antipsychotics,antidepressants,and other drugs may increase the risk of patients falling again.

关 键 词：潜在不适当用药 老年人 股骨颈骨折 用药安全 评估标准 

分 类 号：R969.3[医药卫生—药理学]