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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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    2021-09-13 grace5704
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    2021-09-12 茉莉4297

    有用

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生成对抗网络(GANs)已经成为放射学领域的一个强大工具。与传统的基于DL的检测和分类模型分析现有图像不同,GANs能够生成或修改图像。

BMC Musculoskelet Disord:2岁以下儿童骨折的发生率研究

两岁以下儿童骨折的流行病学研究对于帮助理解意外和虐待性创伤的差异具有重要意义。本系统综述旨在评价两岁以下儿童骨折发生率的研究报告。

【今日分享】成人桡骨远端骨折诊断与治疗循证指南(2024)

针对成人桡骨远端骨折目前国内最为关注的临床问题,本指南共形成27条推荐意见,内容涵盖了桡骨远端骨折保守治疗、手术治疗、康复治疗、临床功能评价、并发症预防及骨质疏松诊治等内容。

Semin Arthritis Rheum:类风湿性关节炎患者骨折风险及早期预测因素

类风湿性关节炎患者的骨折风险明显高于普通人群,尤其是随时间推移功能残疾加重的患者。

Radiology:暗场x线成像增强非移位骨折检测及诊断的可行性

x射线暗场射线成像是一种利用衍射光栅同时从微米大小的干涉图样的局部变化中产生基于衰减和基于x射线散射图像(也称为暗场图像)的显影技术。

手术技巧 | 跟骨板在全身其他部位骨折的妙用

虽然非锁定跟骨板设计用于治疗跟骨骨折,但它们具有一些有趣的特性,证明在目前的足部骨折应用之外使用它是合理的。

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