老年患者抗胆碱能药物使用情况横断面研究

A Cross-Sectional Study on the Use of Anticholinergic Drugs in Elderly Patients

摘要: 目的：采用横断面研究方法，应用Beers标准及抗胆碱能负担分数(ACB分数)对老年患者抗胆碱能负担进行量化，研究65岁及以上老年住院患者抗胆碱能特性药物使用情况，提高老年人用药安全性和合理性。方法：选取2019年1月~2019年3月青岛某三甲医院老年住院患者859名(男437例，女422例)，根据入院诊断将其分为认知障碍组(78例)，无认知障碍组(781例)。收集所有患者住院期间抗胆碱能药物详细用药处方，并对药物进行分类，根据抗胆碱能负担量表(ACB量表)对药物进行评分，分为轻度(1分)、中度(2分)和重度(3分)三个等级。总的抗胆碱能认知负担量表评分≥3被认为与临床相关。数据使用Excel2016进行整理，采用SPSS24.0软件进行统计分析，并使用线性回归和logistic回归分析抗胆碱能负担与各相关因素之间的关系。以p < 0.05判定为有统计学意义。结果：65岁及以上的患者中12.9％的患者抗胆碱能认知负担总评分≥3分。共有33种抗胆碱能药物被使用，其中使用频率最高的是心血管疾病药物，这类药物大多属于ACB 1级药物。5-羟色胺抑制剂是使用频率最高的3级药物。认知障碍组临床相关抗胆碱能负担(ACB总分数≥3)发生率为32%，无认知障碍组发生率为11%，二者有显著性差异，其中认知障碍患者较无认知障碍患者更易发生抗胆碱能负担过重，且MMSE得分与抗胆碱能认知负担显著相关(p < 0.05)。单因素线性回归分析ACB分数和用药种类、用药时长、住院天数、住院次数、西药费之间有着显著的正相关关系，与性别、年龄则无明显相关。多分类Logistic回归分析显示用药种类数与抗胆碱能负担呈正相关。结论：老年患者抗胆能药物使用频率较高。认知障碍患者较无认知障碍患者更易暴露于高抗胆碱能药物处方。认知障碍程度与累积抗胆碱能负担之间存在显着相关性，重度认知障碍导致发生临床相关抗胆碱能认知负担的风险增加。当患者使用抗胆碱能药物总负担分数大于等于3时，临床医师应结合Beers标准及患者病情，换用其他ACB分数小于3的药物或抗胆碱能活性较低的药物，将抗胆碱能总分数降低到小于3，减轻抗胆碱能负担。

Abstract: Objective: To quantify the anticholinergic burden of elderly patients by using Beers standard and anticholinergic burden score (ACB score) by cross-sectional study, and to study the use of anticholinergic drugs in elderly inpatients aged 65 and above, so as to improve the safety and rationality of anticholinergic drugs in the elderly. Methods: A total of 859 elderly inpatients (437 males and 422 females) in a third-class hospital in Qingdao from January 2019 to March 2019 were divided into cognitive impairment group (n = 78) and non-cognitive impairment group (n = 781). The detailed prescriptions of anticholinergic drugs in all patients during hospitalization were collected and classified. The drugs were scored according to the anticholinergic burden scale (ACB scale), which were divided into three grades: mild (1), moderate (2) and severe (3). The total anticholinergic burden score of the drug was calculated from the daily mean of ACB score, and the total anticholinergic cognitive burden scale score ≥ 3 was considered to be clinically related. The data were collated by Excel2016 and statistically analyzed by SPSS24.0 software, and the relationship between anticholinergic burden and related factors was analyzed by linear regression and logistic regression. It was statistically significant when p < 0.05. Results: The total score of anticholinergic cognitive burden was ≥ 3 in 12.9% of the patients aged 65 and above. A total of 33 anticholinergic drugs are used, of which cardiovascular disease drugs are the most frequently used, and most of these drugs belong to ACB class 1 drugs. Serotonin inhibitors are the most frequently used class 3 drugs. The incidence of clinical related anticholinergic burden (ACB total score ≥ 3) was 32% in the cognitive impairment group and 11% in the non-cognitive impairment group. The patients with cognitive impairment were more likely to have excessive anticholinergic burden than those without cognitive impairment, and the MMSE score was significantly correlated with the cognitive burden of anticholinergic. Univariate linear regression analysis showed that there was a significant positive correlation between ACB score and the type of medication, the duration of medication, the days of hospitalization, the number of hospitalization and the cost of western medicine, but not with sex and age. Multiple Logistic regression analysis showed that the number of drugs used was positively correlated with anticholinergic burden. Conclusion: The frequency of anticholinergic drugs is higher in elderly patients. Patients with cognitive impairment are more likely to be exposed to high anticholinergic drugs than those without cognitive impairment. There is a significant correlation between the degree of cognitive impairment and cumulative anticholinergic burden. Severe cognitive impairment leads to an increased risk of clinically related anticholinergic cognitive burden. When the total burden score of anticholinergic drugs used by patients is greater than or equal to 3, clinicians should combine the Beers standard and the patient’s condition, switch to other drugs with ACB scores less than 3 or drugs with lower anticholinergic activity, and reduce the total anticholinergic score to less than 3 to reduce the anticholinergic burden.