药物不良反应致住院，四种药物是主因

链接：http://www.theatlantic.com/healt ... condition-article/0,,20189420,00.html


因发生药物不良反应（ADEs）而急诊住院（ED）在老年患者中很常见。《新英格兰医学杂志》上的一篇研究报告称：四种药物是这类住院事件的主要原因。

    研究人员从全美国范围内有代表性的58家医院内搜集了2007年到2009年间10万例因重大药物不良反应住院的病例。统计后发现，因药物不良反应住院的老年人中，近一半（48%）的年龄超过80岁。这些住院事件中，有三分之二由四种药物引起，这四种药物是：华法林（一种抗凝剂，用于防治血栓）、胰岛素（用于治疗糖尿病）、口服抗血小板药（用于预防心脏病）和口服降糖药（用于治疗糖尿病）。

    既然药物不良反应甚至会导致需急诊住院才能解决的严重后果，我们该如何预防同类事件，保护用药中的老年亲人？

    每个用药者应即时做一个卡片，记录下自己正在使用中的所有药物，并随身携带。患者不一定每次由同一医生接诊，这样的卡片也许就能帮助医生挽救性命。事实上，医学上的重大差错常常是因为医生或病人缺少这样的即时用药记录。

    一半的因药物不良反应而急诊住院事件由抗血栓药和降血糖药引起，所有使用这些药物的病人定期监测血糖和凝血功能，有助于预防因严重低血糖或严重出血导致的住院事件。

    鼓励服药依从性，可延长用药者的寿命。很多病人仅仅因为朋友的建议或互联网上的文章就擅自停药，对坚持服药的益处和停药的坏处却毫不知情。无论是用药、停药、换药，与医生的沟通都是必不可少的。

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We could save significantly on health care use by cutting back on the adverse drug events caused by blood thinners and diabetes meds.


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A few medications cause most of the problems that lead to emergency hospitalization in older patients, according to a recent article in the New England Journal of Medicine.

Adverse drug events (ADEs) leading to emergency department (ED) visits or emergency hospitalizations are particularly common in older patients. By identifying these high risk drugs, hospitalizations can be prevented.

Investigators used 2007-2009 data from a nationally representative sample of 58 hospitals to examine 100,000 hospitalizations due to major drug side effects.

The nearly 100,000 annual emergency hospitalizations caused by ADEs in older patients represent an opportunity to prevent patient harm and lower health care costs.
Almost half (48 percent) of ADE-related hospitalizations among elders occurred in patients older than 80. Four medications accounted for more than two-thirds of these ADE-related emergency hospitalizations: warfarin (a blood thinner to prevent clots), insulins (for diabetes), oral antiplatelet agents (for heart attack prevention), and oral hypoglycemic agents (for diabetes).

The nearly 100,000 annual emergency hospitalizations caused by ADEs in older patients represent an opportunity to prevent patient harm and lower health care use and costs. How can we help our loved ones with their medications?

Make sure an up-to-date card is kept by each person that documents the entire medication list, including vitamins, herbs, and OTC medicines. The list should be kept in their wallet. Some patients see multiple doctors. A handy, up-to-date medication list shown to a physician can save a life. Most critical errors in medicine are related to either the physician or the patient not having a current medication list. As a result, more drug adverse side effects and interactions occur.

Alert your loved ones that blood thinners and diabetic medicines account for 50 percent of hospitalizations due to ADEs. Blood thinners and diabetes medications can regularly be monitored by the primary care physician. Such monitoring should be encouraged to prevent emergency room visits and subsequent hospitalizations due to excessive bleeding or very low blood sugars.

Encouraging medication compliance can lengthen a person's lifespan. Too many times patients stop their medications due to a comment made by a friend or a study that was read on the Internet. Often the doctor is not informed and the patient may not understand the positive effects of the medication. Communication with the physician is essential.

Keeping a medication list, making sure that each medicine is taken, and monitoring high-risk medications should be easy, yet tens of thousands die each year in the U.S. as a result of such mistakes.

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