老年人心血管系统药物潜在不适当用药标准的循证评价

    Potentialiy Inappropriate Medications in The Elderly: A Systematic Review of Cardiovascular Drugs

    • 摘要: 目的 为制定我国老年人潜在不适当用药判断标准和临床用药提供参考。 方法 检索PubMed、EMBASE、中国知网、中国医学文献数据库及万方数据库中已发表的老年人潜在不适当用药标准,以表格形式对纳入文献中的心血管药物进行汇总分析。 结果 纳入22篇老年人潜在不适当用药标准,各个标准的目标人群略有差异(≥65~≥75岁),多数研究对标准的开发过程有详述,但仅少数表明了标准适用范围。各研究涉及到的心血管系统相关药物数差异大(1~30种)。其主要内容为3个方面: ①一般情况下潜在不适当用药;②特定疾病状态下潜在不适当的用药;③老年人应避免的药物-药物相互作用。 结论 各国老年人心血管药物潜在不适当用药标准各有不同,涉及药物广泛,部分药物不适合我国,使用国外老年人潜在不适当用药标准评价我国老年人用药问题不一定恰当,汇总的药物目录可为医生和药师提供简单参考。在制定我国老年人不适当用药标准时,要根据我国临床实践和指南选择性地参考国外标准形成初始老年人潜在不适当用药目录,再采用德尔菲法进行专家咨询。

       

      Abstract: Objective To provide evidence for developing new potentially inappropriate medications (PIM) criteria and promoting rational prescribing in Chinese elders. Methods The authors collected the PIM criteria from the following databases: PubMed,EMBASE,CNKI,CBM and Wangfang. Cardiovascular drugs in the PIM criteria were extracted from included studies and displayed in tables. Results 22 articles were included in our analysis. The age of target population in each studies is different (≥65~≥75 years). Most studies have detailed the development process, but only a few studies have shown the scope of application. The differences among the number of cardiovascular drugs involved in the PIM criteria were significant (1~30 species). The content of drugs mainly contain three parts: independent risk factors, drug-disease interactions, and drug-drug interactions. Conclusion The cardiovascular drugs involved PIM criteria in elderly are various. Some drugs are not stuitable for chinese old people, but these drugs can still proveid a simple reference for doctors and pharrmacists. It is not necessarily appropriate to use the foreign PIM criteria to evaluate the drug problem for Chinese elderiy people. It is ncessary to rely on China's national conditions when we are referring foreign PIM criteria selectively to develop PIM criteria anduse Delphi method experts consultation for the preliminary PIM list.

       

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