精神與心血管藥物對於中老年住院病患跌倒之影響

社區老人之跌倒預防，已有相當多文獻探討；但對於住院病患老人於住院期間預防跌倒發生，目前仍缺乏研究瞭解。本研究之目的在瞭解精神與心血管藥物對於中老年人住院期間跌倒之風險影響，期能作為住院病患跌倒預防之參考。本研究採用病例對照研究法，以台北市某醫學中心2008年1月至2010年3月50歲以上之住院病患為研究對象，將該期間內之住院跌倒病患收為案例組，以一比五配對，選擇案例跌倒期間年齡相近與性別相同之住院病患為對照組，比較兩組間精神與心血管藥物使用狀況、每日全部藥物種類與慢性疾病，並以條件式邏輯回歸作多變項分析。研究結果顯示心血管藥物方面，使用乙型交感神經阻斷劑者有較低跌倒風險(勝算比＝0.25；95%信賴區間＝0.09-0.67)，使用利尿劑者有較高跌倒風險(勝算比＝1.94；95%信賴區間＝1.01-3.73)。精神藥物方面，使用麻醉性止痛劑(勝算比＝2.13；95%信賴區間＝1.07-4.22)與肌肉鬆弛劑(勝算比＝2.40；95%信賴區間＝1.00-5.7)之病患有偏高之跌倒風險。疾病別方面，患有焦慮症之中老年住院患者有邊緣偏高跌倒風險(勝算比＝3.85；95%信賴區間＝0.89-16.6; p = 0.070)。每日藥物使用達六種或以上之病患有較高跌倒風險(勝算比＝3.50；95%信賴區間＝1.42-8.59)。為預防住院期間跌倒，本研究建議對住院之中老年人給予心血管用藥時，若有多重選擇，乙型交感神經阻斷劑可為優先選擇；對於使用利尿劑、麻醉性止痛劑或肌肉鬆弛劑之病患應定期評估該類藥物使用之必要性；每日使用藥物達六種以上之中老年住院病患，應減少不必要之藥物。

關鍵字

跌倒；住院病患；精神作用藥物；麻醉性止痛劑；肌肉鬆弛劑；心血管用藥；乙型交感神經阻斷劑；利尿劑；焦慮症

並列摘要

There is evidence for how to prevent falls in older people dwelling in the community. However, characteristics in older inpatients are likely to be different and few studies have investigated falls prevention for this population, especially the effect of cardiovascular and psychotropic drugs on inpatient falls. The purpose of this study was to examine effects of psychotropic and cardiovascular drugs and polypharmacy on fall risk in older inpatients. A nested case-control study was performed in a tertiary medical center in Taipei city. Cases were defined as those aged 50 years and older who had a fall during hospitalization. A total of 84 cases were reported from January 2008 to March 2010. For each case, five control patients, matched on age and gender, were randomly selected from those who were hospitalized at the time of the index fall. Information on demographics, type and number of psychotropics, cardiovasculars, and other medications before fall, and chronic conditions was collected by reviewing medical records. Conditional logistic regression analyses were applied to investigate independent relationships of psychotropic and cardiovascular medications with the occurrence of a fall, after adjustment for potential confounding variables. Patients who took diuretics, narcotics, and muscle relaxants within one day before fall were 1.94- (95% CI, 1.01-3.73), 2.13- (95% CI, 1.07-4.22), and 2.40-fold (95% CI, 1.00-5.7), respectively, more likely to experience a fall than their counterparts. Conversely, patients who took beta-blockers were less likely to experience a fall than those did not take (OR, 0.25 and 95% CI, 0.09-0.67). Patients who used six or more medications before fall were 3.50-fold (95% CI, 1.42-8.59) more likely to experience a fall than those who did not use, while those with anxiety were 3.85-fold (95% CI, 0.89-16.6; p = 0.070) marginally more likely to experience a fall than those without. In conclusion, beta-blockers should be the drug of choice in treating cardiovascular disorders to prevent inpatient falls. Prescription of diuretics, narcotics, and muscle relaxants for older patients during their hospitalization should be mindfully reviewed on a regular basis. Furthermore, polypharmacy of six or more medications among older patients may be reduced as can as possible.

並列關鍵字

Falls ； Inpatient ； Psychotropic agents ； Narcotics ； Muscle relaxants ； Cardiovascular drugs ； Beta-blockers ； Diuretics ； Anxiety

參考文獻

1. Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clinics in Geriatric Medicine. 2002;18:141-58.

2. Chang JT, Morton SC, Rubenstein LZ. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ. 2004;328:680

3. Ganz DA, Bao Y, et al. Will my patient fall ? JAMA.2007;297:77-86

4. Oliver D, Daly F, Martin FC, et al. Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and Ageing 2004;33: 122–130

5. Leipzig RM, Cumming RG, Tinetti ME. Drug and falls in older people: A systemic review and meta-analysis: I. psychotropic drugs. Journal of American Geriatrics Sociey 1999;47:30-9

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精神與心血管藥物對於中老年住院病患跌倒之影響

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