老年高血压患者高风险用药目录的制定Development of a List of High Risk Medications for the Chinese Elderly Hypertensive Patients
刘晓琦,刘洁,马韵子,李健,张晓娟,陈文颖,劳海燕,杨敏,曾英彤
LIU Xiaoqi,LIU Jie,MA Yunzi,LI Jian,ZHANG Xiaojuan,CHEN Wenying,LAO Haiyan,YANG Min,ZENG Yingtong
摘要(Abstract)：
目的制定适合老年高血压患者的高风险用药目录,保证老年高血压患者用药安全。方法结合我国降压药品上市情况,采用循证方法查阅药品说明书、相关指南及中英文数据库中的相关文献,评价药物安全性,筛选出对老年高血压患者风险较高的药物并整理该类药物的风险点及用药建议,形成初始目录并制成第一轮调查问卷。专家论证过程采用德尔菲法征询专家意见,经过两轮函询根据专家反馈意见形成最终目录,即为老年高血压患者高风险用药目录。结果经过循证评价,共遴选出27个高风险药物、113个风险点及45条用药建议,形成初始目录;初始目录经两轮德尔菲法专家函询论证,最终遴选出氢氯噻嗪、硝苯地平、维拉帕米、哌唑嗪、利血平、可乐定6个高风险药物、12个风险点及12条用药建议制成最终目录。结论初步制定了适合我国老年高血压患者的高风险用药目录,促进老年高血压患者合理用药,降低用药风险。
OBJECTIVE To develop a list of high risk medications applicable to elderly hypertensive patients with an aim to ensure their medication safety. METHODS Refer to the antihypertensive drugs in China,we searched the drug instructions,guidelines and related literatures to access the medication safety. We singled out the medications with high risk for elderly hypertensive patients,and formulated a preliminary list. And then the Delphi method was adopted to seek professional advice,and formed the ultimate list.RESULTS Based on the accessment of literature,27 medications,113 risk points and 45 medication recommendations were selected out in order to form a preliminary list. After two rounds of circularizational argumentation by experts,6 medications( namely Hydrochlorothiazide,Nifedipine,Verapamil,Prazosin,Reserpine,Clonidine),12 risk points as well as 12 medication recommendations were picked to finalize the ultimate list. CONCLUSION The development of the list of high risk medication for Chinese elderly hypertensive patients has been completed preliminarily. The list will promote consciousness of rational drug-use,and improve drug safety in older adult.
关键词(KeyWords)：
老年人;高血压;不良反应;德尔菲法;Beers标准
elderly;hypertension;adverse drug reactions;Delphi method;Beers criteria
基金项目(Foundation): 广州市科技计划项目(201509010012)
作者(Author):
刘晓琦,刘洁,马韵子,李健,张晓娟,陈文颖,劳海燕,杨敏,曾英彤
LIU Xiaoqi,LIU Jie,MA Yunzi,LI Jian,ZHANG Xiaojuan,CHEN Wenying,LAO Haiyan,YANG Min,ZENG Yingtong
参考文献(References)：
- [1]中国人民共和国国家统计局.2010年第六次全国人口普查主要数据公报(第1号)[J].中国计划生育学杂志,2011,19(8):511-512.
- [2]胡大一,刘梅林,郭艺芳.老年高血压的诊断与治疗中国专家共识(2011版)[J].中国医学前沿杂志(电子版),2012,4(2):31-39.
- [3]Beers M H,Ouslander J G,Rollingher J,et al.Explicit criteria for determining inappropriate medication use in nursing home residents[J].Arch Intern Med,1991,151(9):1825-1832.
- [4]Beers M H.Explicit criteria for determining potentially inappropriate medication use by the elderly.An update[J].Arch Intern Med,1997,157(14):1531-1536.
- [5]Fick D M,Cooper J W,Wade W E,et al.Updating the Beers Criteria for potentially inappropriate medication use in older adults:results of a US consensus panel of experts[J].Arch Intern Med,2003,163(22):2716-2724.
- [6]American Geriatrics Society 2012 Beers Criteria Update Expert Panel.American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults[J].J Am Geriatr Soc,2012,60(4):616-631.
- [7]American Geriatrics Society 2015 Beers Criteria Update Expert Panel.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.
- [8]Mc Leod P J,Huang A R,Tamblyn R M,et al.Defining inappropriate practices in prescribing for elderly people:a national consensus panel[J].CMAJ,1997,156(3):385-391.
- [9]Laroche M L,Charmes J P,Merle L.Potentially inappropriate medicationsin the elderly:a French consensus panel list[J].Eur J Clin Pharmacol,2007,63(8):725-731.
- [10]Holt S,Schmiedl S,Thtirmann P A.Potentially inappropriate medications in the elderly:the PRISCUS list[J].Dtseh Arztebl Int,2010,107(31-32):543-551.
- [11]Kim D S,Heo S I,Lee S H.Development of a list of potentially inappropriate drugs for the Korean elderly using the Delphi method[J].Healthy Inform Res,2010,16(4):231-252.
- [12]日本老年医学会.高齢者の安全な薬物療法ガイドライン2015-総論部分[EB/OL].(2015)[2017-01-11].http://www.jpn-geriat-soc.or.jp/info/topics/pdf/20150427_01_02.pdf.
- [13]李星炜,沈芊,李晓玲,等.北京地区基层医疗机构药师干预前后老年患者潜在不适当用药情况调查[J].药物不良反应杂志,2015,17(2):117-120.
- [14]顾艳,刘朵,钱芳,等.2012版Beers标准在老年患者不适当用药评价中的应用[J].中国药房,2015,26(5):704-706.
- [15]闫妍,王育琴,沈芊,等.中国老年人潜在不适当用药目录的研制[J].药物不良反应杂志,2015,17(1):19-26.
- [16]国家卫生计生委合理用药专家委员会,中国医师协会高血压专业委员会.高血压合理用药指南[J].中国医学前沿杂志(电子版),2015,7(6):22-64.
- [17]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华心血管病杂志,2011,39(7):701-708.
- [18]中华医学会心血管病学分会高血压学组.利尿剂治疗高血压的中国专家共识[J].中华高血压杂志,2011,19(3):214-222.
- [19]中国医师协会心血管内科医师分会,中国医师协会高血压专业委员会.血管紧张素受体拮抗剂/氢氯噻嗪固定复方制剂治疗高血压临床应用中国专家共识[J].中华高血压杂志,2012,20(10):928-936.
- [20]孙宁玲,王文,王拥军,等.长效二氢吡啶类钙通道阻滞剂临床应用多学科专家建议书[J].中华内科杂志,2014,53(8):672-676.
- [21]赵连友,孙宁玲,孙英,等.α/β受体阻滞剂在高血压治疗中应用的中国专家共识[J].中华高血压杂志,2016,24(6):521-526.
- [22]中国老年医学学会高血压分会,中国医师协会高血压专业委员会.复方利血平氨苯蝶啶片临床应用中国专家共识[J].中华高血压杂志,2016,24(9):822-826.
- [23]曾光,李辉.现代流行病学方法与应用[M].北京:北京医科大学中国协和医科大学联合出版社,1994:250-270.