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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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| 篇名： | 210例老年择期手术患者术前用药情况评价及药物重整 |
| TITLE： | |
| 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。 |
| ABSTRACT： | 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 5 kinds of diseases； 31.43％ of patients took more than 5 kinds of drug for long term before surgery； 38.10％ patients had more than 2 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. |
| 期刊： | 2019年第30卷第1期 |
| 作者： | 张微微，孟慧杰，谢吉科，席庆，颜妍，胡永芳 |
| AUTHORS： | ZHANG Weiwei，MENG Huijie，XIE Jike，XI Qing，YAN Yan，HU Yongfang |
| 关键字： | 老年患者；药物重整；术前用药；用药安全 |
| KEYWORDS： | Elderly patients； Medication reconciliation； Preoperative medication； Medication safety |
| 阅读数： | 387 次 |
| 本月下载数： | 30 次 |
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