北京多社區衛生服務中心老年患者處方降脂藥物合理應用分析

羅冬梅　馬立萍　高緒霞　申學謙　熊緒臣　馬玉潔　祁緣

摘要：目的 ?分析社區老年高脂血癥患者降脂藥物處方情況，促進老年患者降脂藥物合理應用。方法 ?收集北京安貞醫院醫聯體4家社區衛生服務中心2019年12月1～12日門診就診的老年患者處方各300張，分析不同社區不同種類降脂藥物應用情況、降脂藥物使用情況、聯合用藥情況。結果 ?4家社區衛生服務中心1200份處方中258份為包含降脂藥物的處方，其中大屯社區、金盞社區、潞城社區、甘棠社區中含降脂的藥物處方分別有112例、66例、27例、53例。4家社區中應用最多的降脂藥物均為他汀類，其次為膽固醇吸收抑制劑，其余種類的降脂藥應用較少。降脂藥物的聯合應用處方共13例，兩種他汀藥物聯合應用3例，聯合應用種類共有5種，其中他汀類與膽固醇吸收抑制劑（依折麥布）的聯合應用最多。不合理的降脂藥物與非降脂藥物聯合用藥情況中有1例辛伐他汀與紅霉素聯合應用，5例辛伐他汀與氨氯地平聯合應用。結論 ?4家社區衛生服務中心老年患者降脂藥物總體應用合理，存在少數潛在不良反應風險的聯合用藥處方，臨床需注意監測和隨訪。

關鍵詞：老年患者;高脂血癥;合理用藥

中圖分類號：R19 ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?文獻標識碼：A ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?DOI：10.3969/j.issn.1006-1959.2020.18.041

文章編號：1006-1959（2020）18-0127-03

Analysis of Rational Application of Lipid-lowering Drugs Prescribed by Elderly Patients

in Beijing Multi-community Health Service Centers

LUO Dong-mei1，MA Li-ping2，GAO Xu-xia2，SHEN Xue-qian1，XIONG Xu-chen1，MA Yu-jie1，QI Yuan1

（1.The Sixth School of Clinical Medicine，Capital Medical University，Beijing 100069，China;

2.Department of General Medicine，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China）

Abstract：Objective ?To analyze the prescription of lipid-lowering drugs in elderly patients with hyperlipidemia in the community， and promote the rational use of lipid-lowering drugs in elderly patients.Methods ?A collection of 300 prescriptions for elderly patients from the outpatient clinics of 4 community health service centers in Beijing Anzhen Hospital Medical Consortium from December 1 to 12， 2019 were collected， and the application of different types of lipid-lowering drugs in different communities was analyzedcombination medication situation.Results ?Of the 1，200 prescriptions from 4 community health service centers， 258 were prescriptions containing lipid-lowering drugs. Among them， there were 112 and 66 prescriptions for lipid-lowering drugs in Datun， Jinzhan， Lucheng， and Gantang communities， respectively， 27 cases， 53 cases. The most commonly used lipid-lowering drugs in the 4 communities are statins， followed by cholesterol absorption inhibitors， and the remaining types of lipid-lowering drugs are less used. There were 13 prescriptions for combined application of lipid-lowering drugs， 3 cases of combined application of two statins， and 5 types of combined applications. Among them， the combination of statins and cholesterol absorption inhibitors （ezetimibe） was used the most. In the unreasonable combination of lipid-lowering drugs and non-lipid-lowering drugs， there was 1 case of simvastatin combined with erythromycin， and 5 cases of simvastatin combined with amlodipine.Conclusion ?The overall application of lipid-lowering drugs for elderly patients in the 4 community health service centers was reasonable， and there were a few combination prescriptions for potential adverse reactions. Clinical monitoring and follow-up were necessary.

Key words：Elderly patients;Hyperlipidemia;Rational drug use

高脂血癥（hyperlipidemia）包括高膽固醇血癥、高甘油三酯血癥、混合型高脂血癥和高密度脂蛋白膽固醇（HDL-C）降低血癥，過多的脂質可沉積于皮膚局部出現黃色瘤，沉積于血管內皮下可引起動脈粥樣硬化，導致心腦血管與周圍血管病變，增加冠心病、心肌梗死、腦卒中等疾病的發生風險[1，2]?！?br>