BMJ:我国学者:使用抗精神病药物和胆碱酯酶抑制剂与跌倒和骨折的风险

2021-09-11 MedSci原创 MedSci原创

患有严重神经认知障碍的老年人通常身体较为虚弱,容易发生跌倒和相关的骨折。

患有严重神经认知障碍的老年人通常身体较为虚弱,容易发生跌倒和相关的骨折。跌倒和骨折是老年人入院的最常见原因,与大量的发病率和死亡率有关。胆碱酯酶抑制剂通常用于改善认知能力,由于副交感神经作用引起的晕厥,可能与跌倒和骨折的风险有关。

抗精神病药物通常用于治疗主要神经认知障碍患者的神经精神症状,并引起对跌倒和骨折的关注。由于抗精神病药物的潜在不良反应,包括直立性低血压、镇静、视力模糊和锥体外系症状,FDA建议在开始治疗前应对跌倒的风险进行全面评估。Beers标准也表明,抗精神病药物可能与跌倒和骨折的风险有关。

尽管一些研究和指南认为,胆碱酯酶抑制剂和抗精神病药物可能与跌倒和骨折的风险有关,但其他研究得出了不同的结论。Kim等人发现在主要神经认知障碍患者中,使用胆碱酯酶抑制剂与跌倒和骨折的发生率没有关系。

此外,一项系统回顾和荟萃分析以及一项观察性研究也发现,抗精神病药物与跌倒和骨折的风险没有关系。有主要神经认知障碍的神经精神症状的患者可能表现为抑郁、易怒、烦躁和幻觉,这可能导致抗精神病药物的处方,而症状和治疗都可能增加随后跌倒和骨折的风险。

为了全面评价使用抗精神病药物和胆碱酯酶抑制剂与患有严重神经认知障碍的老年患者跌倒和骨折风险之间的关系,来自台湾台南成功大学医学院临床药学与药学研究所药学系的专家开展了一项自我对照病例研究,结果发表在BMJ杂志上。

研究人员使用台湾国家健康保险数据库。纳入15278名成年人,年龄≥65岁,新开抗精神病药物和胆碱酯酶抑制剂,在2006年至2017年间发生过跌倒或骨折。胆碱酯酶抑制剂的处方记录确认了主要神经认知障碍的诊断;所有胆碱酯酶抑制剂的使用都由专家审查。

研究方案和治疗期的定义

主要结局措施是与同一人的非治疗期相比,单独使用胆碱酯酶抑制剂、单独使用抗精神病药物、胆碱酯酶抑制剂和抗精神病药物的组合不同治疗期的跌倒和骨折风险。

结果显示,每100人年的跌倒和骨折发生率在非治疗期为8.30(95%CI:8.14-8.46),在治疗前为52.35(48.46-56.47),而在联合使用胆碱酯酶抑制剂和抗精神病药物,单独使用抗精神病药物,和单独使用胆碱酯酶抑制剂治疗后则分别为10.55(9.98-11.14),10.34(9.80-10.89),和9.41(8.98-9.86)。

不同研究时期的跌倒和骨折风险

与非治疗期相比,治疗前的跌倒和骨折风险最高(RR=6.17,95%CI:5.69-6.69),其次是使用胆碱酯酶抑制剂和抗精神病药物联合治疗(1.35,1.26-1.45),单独使用抗精神病药物(1.33,1.24-1.43),以及单独使用胆碱酯酶抑制剂(1.17,1.10-1.24)。

综上,与非治疗期相比,治疗期与较高的跌倒和骨折风险有关。在患者恢复更稳定的身体和精神状态之前,预防和密切监测跌倒风险的策略仍然是必要的。

 

参考文献:

Use of antipsychotic drugs and cholinesterase inhibitors and risk of falls and fractures: self-controlled case series. BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n1925

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    2022-04-24 gaoxiaoe
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    2022-07-12 jklm09
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    2021-09-13 grace5704
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    2021-09-12 茉莉4297

    有用

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骨质疏松症是一个主要的公共健康问题,在世界范围内的患病率持续增长。脆性骨折被定义为与高冲击性创伤无关的不全性骨折,是骨质疏松症诊断和治疗不足的主要并发症。

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【热点解读分享】老年髋部骨折患者围术期深静脉血栓形成预防和管理的最佳证据研究

老年髋部骨折DVT的预防形成及管理最佳证据可为临床提供决策依据。临床应用时,应基于临床情景,合理应用证据,提升临床护理质量,以降低DVT的发生。

NEJM:性腺功能减退症人群采用睾酮治疗可能提高骨折的风险

在过去的几十年中,女性和男性性激素对骨骼肌和骨骼健康的重要性已得到认可。虽然有多种性激素,但研究最多的是雌激素和睾酮。雌激素和睾酮都存在于男性和女性中,这两种激素都对骨骼肌和骨骼产生直接和间接的影响。

粉碎髌骨的张力带如何固定?

老年患者治疗的首要目标是恢复功能。治疗以骨质量、骨折模式、体检以及患者的功能状态和医疗合并症为指导。治疗选择包括非手术治疗、切开复位内固定、部分髌骨切除术以及极少数情况下的全髌骨切除术。

是否存在真正意义上的Schatzker III型胫骨平台骨折?

胫骨平台骨折最常用的分型为Schatzker分型和AO分型,Schatzker在1974年提出了胫骨平台的分型系统,并在1979年进行改良。