2021 年第 1 期 第 16 卷

社区卫生服务中心老年糖尿病患者处方多重用药情况分析

Analysis of prescriptions for elderly diabetic patients from community health service centers

作者：申学谦1高绪霞2马立萍2罗冬梅1马玉洁1熊绪臣1祁缘1

英文作者：Shen Xueqian1 Gao Xuxia2 Ma Liping2 Luo Dongmei1 Ma Yujie1 Xiong Xuchen1 Qi Yuan1

单位：1首都医科大学第六临床医学院医学系2016级，北京100029；2首都医科大学附属北京安贞医院全科医疗科100029

英文单位：1Student of Grade 2016 Department of Medicine Sixth Clinical Medical College Capital Medical University Beijing 100029 China; 2Department of General Practice Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：糖尿病；老年患者；合理用药；多重用药

英文关键词：Diabetesmellitus;Elderlypatients;Rationaldruguse;Polypharmacy 

• 摘要：

• 目的 调查北京部分社区卫生服务中心老年糖尿病患者处方中多重用药（≥5种/d）发生率，分析多重用药可能原因及降糖药物使用合理性。方法 收集2019年12月1—12日在首都医科大学附属北京安贞医院4家医联体社区卫生服务中心就诊的60岁及以上老年患者的处方共1 200例，录入处方信息进行描述性分析。结果 1 200例处方中309例为糖尿病患者处方。91例（29.4%）患者存在多重用药，合并疾病种类多、降糖药物使用种类多是影响多重用药的可能原因。降糖药物中单药治疗占57.9%（179/309），单药治疗中二甲双胍使用率最高［30.7%（55/179）］。新型降糖药物钠-葡萄糖共转运蛋白2抑制剂、胰高血糖素样肽1激动剂、二肽基肽酶4抑制剂在4家社区卫生服务中心较少应用。不同种类降糖药物之间的联合未见不合理应用情况。结论 首都医科大学附属北京安贞医院4家医联体卫生服务中心老年糖尿病患者多重用药比例较高，糖尿病合并多种其他疾病和使用降糖药物种类多是可能的影响因素。糖尿病治疗以传统降糖药物为主，药物应用合理，但是具有心、肾器官保护作用的新型降糖药物应用较少。

• Objective To investigate the incidence of polypharmacy, possible affecting factors of the polypharmacy (≥5 kinds/d) and rationality of antidiabetic medicines administration in prescriptions for elderly patients at some community health service centers in Beijing. Methods From December 1st to December 12th, 2019, 1 200 cases of elderly patients aged 60 years and above were collected from four medical union community health service centers of Beijing Anzhen Hospital, Capital Medical University. The prescription information was input for descriptive analysis. Results A total of 1 200 prescriptions were collected, including 309 prescriptions of diabetic patients. There were 91 patients(29.4%) with polypharmacy, and combining with multiple chronic diseases and multiple kinds of hypoglycemic drugs for one patient were the possible factors for the polypharmacy. In hypoglycemic drugs, single drug treatment accounted for 57.9%(179/309) and metformin had the highest utilizationrate［30.7%(55/179）］ in single drug treatment. The new types of hypoglycemic drugs were rarely prescribed in the four community health service centers, including sodium-glucose co-transporter 2 inhibitor, glucagon-likepeptide-1 agonist and dipeptidyl peptidase 4 inhibitors. No unreasonable use was found in the combination of different kinds of hypoglycemic drugs. Conclusions  There is a high proportion of polypharmac use in elderly patients with diabetes in four medical union community health service centers of Beijing Anzhen Hospital, Capital Medical University. Diabetes complicated with many other diseases and the use of different hypoglycemic drugs are the possible influencing factors. Traditional hypoglycemic drugs are mainly used in the treatment of diabetes mellitus, and the drug application is reasonable. However, the application of new hypoglycemic drugs with cardiac and renal organ protection is rare.