210例老年择期手术患者术前用药情况评价及药物重整
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摘要
目的:调查并评价老年择期手术患者术前用药情况,为临床药师对老年患者术前用药的管理提供参考。方法:以2015年10月-2016年10月在北京清华长庚医院进行择期手术的210例老年患者为研究对象,药师对其进行药物重整,获取其疾病及用药信息,并依据《老年患者最佳术前评估指南》对术前用药情况(如用药适应证、用法用量、相互作用、药物选择及术前是否需要停用等)进行分析及评价,提供相关用药建议。结果:在210例患者中,男性132例(62.86%)、女性78例(37.14%),平均年龄(69.96±7.67)岁;43.81%的患者患有3种以上疾病,13.33%的患者患有5种以上疾病;31.43%的患者术前长期用药≥5种;38.10%患者存在2种以上用药风险;110例(52.38%)患者术前用药中包含术前应避免使用的药物(如抗血小板聚集药),23例(10.95%)患者存在潜在不适当用药(如质子泵抑制药),12例(5.71%)患者存在应谨慎使用的药物(如阿司匹林),35例(16.67%)患者包含术前应继续使用的药物(如β受体阻滞药);药师通过药物重整及术前用药评估为患者和医师提出如停药等用药建议共计177例次(患者71次、医师106次),最终采纳率分别为100%、95.28%。结论:老年患者术前合并疾病多、用药风险因素多、多重用药常见,应重视术前用药管理;药物重整是开展老年患者术前用药管理的有效途径,老年患者术前用药评估及分析对保证临床用药安全具有重要意义。
OBJECTIVE:To investigate and evaluate perioperative medication in elective surgery elderly patients,and to provide reference for perioperative medication management of clinical pharmacists for elderly patients. METHODS:Totally 210 elective surgery elderly patients were selected from Beijing Tsinghua Chang Gung Hospital during Oct. 2015 to Oct. 2016.Pharmacists carried out drug reconstitution,obtained information about their diseases and medication,analyzed and evaluated perioperative medication(indication,usage and dosage,interaction,drug selection,if these drugs should be stopped before surgery) according to Optimal Guidelines for Preoperative Evaluation of Elderly Patients so as to put forward related medication suggestions. RESULTS:Among 210 patients,there were 132 males(62.86%) and 78 females(37.14%) with an average age of(69.96±7.67)years;43.81% of patients had more than 3 kinds of diseases,and 13.33% of patients suffered from more than 5kinds of diseases;31.43% of patients took more than 5 kinds of drug for long term before surgery;38.10% patients had more than2 drug-induced risks;The preoperative medication of 110 patients(52.38%)included drugs that should be avoided before surgery(such as antiplatelet aggregation agents),23 patients(10.95%) had potentially inappropriate medication(such as proton pump inhibitors),12 patients(5.71%)should use drugs(such as aspirin)cautiously,35 patients(16.67%) should use drugs(β receptor blocker)continuously during perioperative period. The pharmacists provided 177 times of medication suggestions such as stopping some medications for patients and physicians through medication reconciliation and preoperative medication evaluation(71 times for patients,106 times for physicians);the final adoption rates were 100% and 95.28%,respectively. CONCLUSIONS:The elderly patients have many preoperative complications, various risk factors, multiple medications, so it is vital for their preoperative medication management. The medication reconciliation is an effective way to evaluate preoperative medication in elderly patients,preoperative medication evaluation and analysis in elderly patients is of great significance to ensure the safety of clinical medication.
OBJECTIVE:To investigate and evaluate perioperative medication in elective surgery elderly patients,and to provide reference for perioperative medication management of clinical pharmacists for elderly patients. METHODS:Totally 210 elective surgery elderly patients were selected from Beijing Tsinghua Chang Gung Hospital during Oct. 2015 to Oct. 2016.Pharmacists carried out drug reconstitution,obtained information about their diseases and medication,analyzed and evaluated perioperative medication(indication,usage and dosage,interaction,drug selection,if these drugs should be stopped before surgery) according to Optimal Guidelines for Preoperative Evaluation of Elderly Patients so as to put forward related medication suggestions. RESULTS:Among 210 patients,there were 132 males(62.86%) and 78 females(37.14%) with an average age of(69.96±7.67)years;43.81% of patients had more than 3 kinds of diseases,and 13.33% of patients suffered from more than 5kinds of diseases;31.43% of patients took more than 5 kinds of drug for long term before surgery;38.10% patients had more than2 drug-induced risks;The preoperative medication of 110 patients(52.38%)included drugs that should be avoided before surgery(such as antiplatelet aggregation agents),23 patients(10.95%) had potentially inappropriate medication(such as proton pump inhibitors),12 patients(5.71%)should use drugs(such as aspirin)cautiously,35 patients(16.67%) should use drugs(β receptor blocker)continuously during perioperative period. The pharmacists provided 177 times of medication suggestions such as stopping some medications for patients and physicians through medication reconciliation and preoperative medication evaluation(71 times for patients,106 times for physicians);the final adoption rates were 100% and 95.28%,respectively. CONCLUSIONS:The elderly patients have many preoperative complications, various risk factors, multiple medications, so it is vital for their preoperative medication management. The medication reconciliation is an effective way to evaluate preoperative medication in elderly patients,preoperative medication evaluation and analysis in elderly patients is of great significance to ensure the safety of clinical medication.
引文
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[2]LORAN DB,HYDE BR,ZWISCHENBERGER JB.Perioperative management of special populations:the geriatric patient[J].Surg Clin North Am,2005,85(6):1259-1266.
[3]QATO DM,WILDER J,SCHUMM LP,et al.Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States,2005 vs 2011[J].JAMA Intern Med,2016,176(4):473-482.
[4]滕晋,王丹,徐熙,等.老年患者多重用药调查及共病管理的临床策略[J].中国卫生事业管理,2015,32(9):695-697.
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[6]KENNEDY JM,VAN RIJ AM,SPEARS GF,et al.Polypharmacy in a general surgical unit and consequences of drug withdrawal[J].Br J Clin Pharmacol,2000,49(4):353-362.
[7]杨谦梓,薄禄龙.围术期用药安全:临床现状与指南解读[J].麻醉安全与质控,2017,1(4):163-167.
[8]JIN F,CHUNG F.Minimizing perioperative adverse events in the elderly[J].Br J Anaesth,2001,87(4):608-624.
[9]COFFEY M.Medication reconciliation:coming to a hospital near you[J].J Paediatr Child Health,2009,14(2):76-77.
[10]MUELLER SK,SPONSLER KC,KRIPALANI S,et al.Hospital-based medication reconcilimion practices:a systematic review[J].Arch Intern Med,2012,72(14):1057-1069.
[11]刘莹,崔向丽,刘丽宏.国内外药物重整研究进展[J].中国药学杂志,2015,50(24):2099-2102.
[12]MCCARTHY L,SU XW,CROWN N,et al.Medication reconciliation interventions in ambulatory care:a scoping review[J].Am J Health Syst Pharm,2016,73(22):1845-1857.
[13]WARREN BC,CLIFFORD YK,RONNIE AR,et al.ACSNSQIP?/AGS best practice guidelines:optimal preoperative assessment of the geriatric surgical patient[EB/OL].(2014-05-13)[2015-01-10].https://www.facs.org/~/media/files/quality%20programs/nsqip/acsnsqipagsgeriatric2012guidelines.ashx.
[14]MJ Samuel.American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2015,63(11):2227-2246.
[15]许幸,吴新民.麻醉中药物的相互作用[J].中国医院用药评价与分析,2001,1(1):44-45.
[16]VISALA M,DAVID SM,STEVEN LC,et al.Perioperative medication management[DB/OL].(2018-08-09)[2018-08-18].http://www.uptodate.com/contents/perioperativemedication-management?search=%E5%9B%B4%E6%89%8B%E6%9C%AF%E6%9C%9F%E7%94%A8%E8%8D%AF%E7%AE%A1%E7%90%86&source=Out+of+date+-+zh-Hans&selectedTitle=1%7E51.
[17]周海峰,沈杰,纪芳,等.Beers标准联合STOPP/START准则评价我院内科老年住院患者潜在不适当用药[J].中国药房,2016,27(33):3212-3214.
[18]张海苗,张博江,褚静,等.应用2015版Beers标准综合评价老年住院患者潜在不适当用药[J].实用药物与临床,2018,21(4):448-451.
[19]ANG-LEE MK,MOSS J.Herbal medicines and perioperative care[J].JAMA,2001,286(2):208-216.
[20]ROSENMAN DJ,MCDONALD FS,EBBERT JO,et al.Clinical consequences of with holding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period[J].J Hosp Med,2008,3(4):319-325.
[21]DRENGER B,FONTES ML,MIAO Y,et al.Patterns of use of perioperative angiotensin-converting enzyme inhibitors in coronary artery bypass graft surgery with cardiopulmonary bypass:effects on in-hospital morbidity and mortality[J].Circulation,2012,126(3):261-269.
[22]TURAN A,YOU J,SHIBA A,et al.Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery[J].Anesth Analg,2012,114(3):552-560.
[2]LORAN DB,HYDE BR,ZWISCHENBERGER JB.Perioperative management of special populations:the geriatric patient[J].Surg Clin North Am,2005,85(6):1259-1266.
[3]QATO DM,WILDER J,SCHUMM LP,et al.Changes in prescription and over-the-counter medication and dietary supplement use among older adults in the United States,2005 vs 2011[J].JAMA Intern Med,2016,176(4):473-482.
[4]滕晋,王丹,徐熙,等.老年患者多重用药调查及共病管理的临床策略[J].中国卫生事业管理,2015,32(9):695-697.
[5]BETTELLI,G.Perioperative care of the elderly:polymedication and perioperative medication management[M].Cambridge:Cambridge University Press,2017:30-37.
[6]KENNEDY JM,VAN RIJ AM,SPEARS GF,et al.Polypharmacy in a general surgical unit and consequences of drug withdrawal[J].Br J Clin Pharmacol,2000,49(4):353-362.
[7]杨谦梓,薄禄龙.围术期用药安全:临床现状与指南解读[J].麻醉安全与质控,2017,1(4):163-167.
[8]JIN F,CHUNG F.Minimizing perioperative adverse events in the elderly[J].Br J Anaesth,2001,87(4):608-624.
[9]COFFEY M.Medication reconciliation:coming to a hospital near you[J].J Paediatr Child Health,2009,14(2):76-77.
[10]MUELLER SK,SPONSLER KC,KRIPALANI S,et al.Hospital-based medication reconcilimion practices:a systematic review[J].Arch Intern Med,2012,72(14):1057-1069.
[11]刘莹,崔向丽,刘丽宏.国内外药物重整研究进展[J].中国药学杂志,2015,50(24):2099-2102.
[12]MCCARTHY L,SU XW,CROWN N,et al.Medication reconciliation interventions in ambulatory care:a scoping review[J].Am J Health Syst Pharm,2016,73(22):1845-1857.
[13]WARREN BC,CLIFFORD YK,RONNIE AR,et al.ACSNSQIP?/AGS best practice guidelines:optimal preoperative assessment of the geriatric surgical patient[EB/OL].(2014-05-13)[2015-01-10].https://www.facs.org/~/media/files/quality%20programs/nsqip/acsnsqipagsgeriatric2012guidelines.ashx.
[14]MJ Samuel.American Geriatrics Society 2015 updated Beers criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2015,63(11):2227-2246.
[15]许幸,吴新民.麻醉中药物的相互作用[J].中国医院用药评价与分析,2001,1(1):44-45.
[16]VISALA M,DAVID SM,STEVEN LC,et al.Perioperative medication management[DB/OL].(2018-08-09)[2018-08-18].http://www.uptodate.com/contents/perioperativemedication-management?search=%E5%9B%B4%E6%89%8B%E6%9C%AF%E6%9C%9F%E7%94%A8%E8%8D%AF%E7%AE%A1%E7%90%86&source=Out+of+date+-+zh-Hans&selectedTitle=1%7E51.
[17]周海峰,沈杰,纪芳,等.Beers标准联合STOPP/START准则评价我院内科老年住院患者潜在不适当用药[J].中国药房,2016,27(33):3212-3214.
[18]张海苗,张博江,褚静,等.应用2015版Beers标准综合评价老年住院患者潜在不适当用药[J].实用药物与临床,2018,21(4):448-451.
[19]ANG-LEE MK,MOSS J.Herbal medicines and perioperative care[J].JAMA,2001,286(2):208-216.
[20]ROSENMAN DJ,MCDONALD FS,EBBERT JO,et al.Clinical consequences of with holding versus administering renin-angiotensin-aldosterone system antagonists in the preoperative period[J].J Hosp Med,2008,3(4):319-325.
[21]DRENGER B,FONTES ML,MIAO Y,et al.Patterns of use of perioperative angiotensin-converting enzyme inhibitors in coronary artery bypass graft surgery with cardiopulmonary bypass:effects on in-hospital morbidity and mortality[J].Circulation,2012,126(3):261-269.
[22]TURAN A,YOU J,SHIBA A,et al.Angiotensin converting enzyme inhibitors are not associated with respiratory complications or mortality after noncardiac surgery[J].Anesth Analg,2012,114(3):552-560.
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