385例多重用药的老年细菌性肺炎住院患者药品不良反应特点及影响因素分析  

Adverse Drug Reaction in 385 Elderly Inpatients with Bacterial Pneumonia under Polypharmacy

作　　者：刘碧晴 张晓彤 王可[1] 邢晓璇[1] 王之舟[1] 庄伟[1] 张青霞[1] 张兰[1] 李晓玲[1] 董宪喆 LIU Biqing;ZHANG Xiaotong;WANG Ke;XING Xiaoxuan;WANG Zhizhou;ZHUANG Wei;ZHANG Qingxia;ZHANG Lan;LI Xiaoling;DONG Xianzhe(Department of Pharmacy,Xuanwu Hospital of Capital Medical University,National Gerontic Disease Clinical Research Center,Beijing 100053,China;Department of Pharmacy,Children’s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China;School of Pharmaceutical Sciences,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学宣武医院药学部,国家老年疾病临床医学研究中心,北京100053 [2]首都儿科研究所附属儿童医院药学部,北京100020 [3]首都医科大学药学院,北京100069

出　　处：《中国药物警戒》2025年第2期206-210,216,共6页Chinese Journal of Pharmacovigilance

基　　金：国家重点研发计划(2020YFC2008305);北京市科技计划(D181100000218002)。

摘　　要：目的分析多重用药的老年细菌性肺炎住院患者药品不良反应(Adverse Drug Reaction,ADR)特点及相关影响因素。方法回顾性分析2018年1月1日至2022年11月30日于首都医科大学宣武医院住院的老年细菌性肺炎患者情况,采用Naranjo评定法评价药物与ADR之间的关联性,采用《不良事件通用术语评价标准》(5.0版)对ADR的严重程度进行分级;运用向后选择法建立Logistic回归方程对危险因素进行分析。结果4967例老年细菌性肺炎住院患者中有385名患者发生464例次ADR,发生率为7.75%。ADR类型主要分布在胃肠系统(40.52%)、循环系统(14.44%)及肝功能损伤(12.28%)等。ADR共涉及相关药物671例次,主要为抗感染药物(63.79%)、抗凝药(6.56%)和抗血小板药物(6.41%)。ADR严重程度主要为1级(30.17%)和2级(59.91%)。多因素Logistic回归结果显示,住院天数、用药种数、药物过敏史、女性患者、脑血管疾病和结缔组织病会增加患者发生ADR的风险。结论通过分析老年细菌性肺炎患者发生ADR的危险因素,提示临床应加强对高风险患者ADR的监护与管理,为未来进一步开发老年细菌性肺炎住院患者ADR风险预测模型提供参考。Objective To analyze the characteristics of and risk factors for adverse drug reactions(ADR)in elderly inpatients with bacterial pneumonia and treated with polypharmacy.Methods The clinical data of elderly inpatients with bacterial pneumonia treated between January 1,2018 and November 30,2022 was retrospectively analyzed.The correlations between drugs and ADR were evaluated using the Naranjo evaluation method while the severity of ADR was graded with Common Terminology Criteria for Adverse Events version 5.0.A logistic regression equation was established using the backward selection method to analyze the risk factors.Results Among the 4967 elderly inpatients with bacterial pneumonia,there were 464 cases of ADR in 385 of these patients,so the overall incidence rate of ADR was 7.75%that were mostly related to the gastrointestinal system(40.52%),circulatory system(14.44%)and liver function injury(12.28%).A total of 671 related drugs were involved in ADR,such as anti-infective drugs(63.79%),anticoagulants(6.56%)and antiplatelet drugs(6.41%).The severity of ADR was primarily grade 1(30.17%)and grade 2(59.91%).Multivariate logistic regression results showed that days of hospitalization,numbers of medications,drug allergy history,being female,cerebrovascular diseases and connective tissue diseases increased the risk of ADR in patients.Conclusion Clinicians and pharmacists should be alert to ADR in high-risk patients.This study is expected to contribute to the development of risk prediction models of ADR for elderly inpatients with bacterial pneumonia in the future.

关 键 词：细菌性肺炎 老年患者 多重用药 胃肠系统 抗感染药物 药品不良反应 Logistic回归 

分 类 号：R798.1[医药卫生—临床医学] R743