因药物不良反应事件导致急诊

11,23,44,51.2.3.4.5.(negligence)(adversedrugevent)1991(HMSHSPH)31,429(adverseevent)3.7%27.6%(1.0%)16.2%(2.6%)(13.6%)NEnglMedJ1991;324:370-62(19.4%)ADE()()()1964-199539meta-analysisADE2.1%ADE0.19%ADE4.7%0.13%ADEtypeA(76.2%)NEnglMedJ1991;324:377-84JAMA1998;279:1200-51994ADE106,000(95%CI76,000-137,000)4.6%46273218.2%(64)(69)ADE1,0009.5(0.95%)ADE9(1987-1995)JAMA1998;279:1200-5ArchInternMed2001;161:2317-23ArchInternMed1997;157:1569-763ADEBostoncase-controlstudyADE2.23,244ADE1.92,2622ADEADEADEJAMA1997;277:307-11JAMA1997;277:301-6(case-controlstudy)March2004~April2005*()ADE(Naranjoscore)ADE*20043~84(preventable)ADEADE(21)ADE()ADEstudentttestχ2squaretestconditionallogisticregression(n=534)(n=14,904)p()339(63.5%)9,374(62.9%)0.7()158(29.6%)195(36.5%)181(33.9%)0(0.0%)1,896(12.7%)6,674(44.7%)6,333(42.5%)1(0.0%)0.001247(46.3%)287(53.7%)7,006(47.0%)7,898(53.0%)0.7()122(22.8%)110(20.1%)102(19.1%)96(18.0%)104(19.5%)3,335(22.4%)2,970(20.0%)2,802(18.8%)2,877(19.3%)2,920(19.6%)1.00-8()8-1616-2478(14.6%)261(48.9%)195(36.5%)2,796(18.8%)6,606(44.3%)5,502(36.9%)0.031-4()5-89-1213-1617-2021-2482(15.3%)88(16.5%)93(17.4%)87(16.3%)95(17.8%)89(16.7%)2,340(15.7%)2,470(16.6%)2,322(15.6%)2,398(16.1%)2,635(17.7%)2,739(18.4%)0.5()66.4±17.861.7±20.50.0001*60815,438534(3.5%)ADE93319381553414,9045(%)(aspirinisorsorbidedinitrate)28(5.2)(atenololnifedipine)67(12.6)(amiodaronedigoxin)9(1.7)(furosemidehydrochlorothiazide)21(3.9)(diphenhydraminechlorpheniramine)2(0.4)(diazepamflunitrazepam)24(4.5)(glibenclamidegliclazideinsulinsteroid)94(17.6)(cisplatindocetaxelvinorelbine)71(13.3)(amitriptylinefluoxetinelithium)6(1.1)(haloperidololanzapinesulpiride)11(2.1)(diclofenacnimesulidecelecoxib)88(16.5)/(tolperisonephenytoincarbamazepine)8(1.5)(ethambutolrifampinpenicillinsulfonamide)25(4.7)(coumadinheparin)29(5.4)(calciumpotassium)2(0.4)(metoclopramidesennaleafenema)16(3.0)(datura)11(2.1)(theophyllinecontrastmedium)22(4.1)933193815534534273(51.1%)3043.6%(233)ADE(62.6%)(75.5%)Naranjoscore3-4(possibleADE)1755-8(probableADE)358≥9(definiteADE)1534ADE15(haldoltrihexyphenidyl)46059()234(43.8%)(1-131median8.5)122(22.8%)1-6(median1)178ADE13(2.4%)102(19.1%)376(70.4%)43(8.1%)6(n=534%)(n=1068%)p()66.4±17.863.4±20.40.004()339(63.5)696(65.2)0.5()247(46.3)501(46.9)0.8()158(29.6)195(36.5)181(33.9)316(29.6)390(36.5)362(33.9)--0-8()8-1616-2478(14.6)261(48.9)195(36.5)151(14.1)529(49.5)388(36.3)--223(41.8)303(56.7)8(1.5)285(26.7)689(64.5)94(0.9)0.001()327(61.2)16(1.5)0.001()334(62.5)64(12.0)9(1.7)127(23.8)274(25.7)13(1.2)4(0.3)777(72.8)0.001()403(75.5)11(2.1)20(3,7)60(11.2)40(7.5)510(47.8)6(0.6)9(0.8)18(1.7)525(49.2)0.001295(55.2)436(40.8)0.00117(3.2)57(5.3)0.0527(5.1)29(2.7)0.0277(14.4)54(5.1)0.00167(12.5)89(8.3)0.0151(9.6)51(4.8)0.00133(6.2)24(2.2)0.0019(1.7)6(0.6)0.030(CharlsonComorbidityScore)12-34-6≥7148(27.7)97(18.2)124(23.2)101(18.9)64(12.0)418(39.1)198(18.5)245(22.9)150(14.0)57(5.3)0.00124(4.5)25(2.3)0.0256(10.5)9(0.8)0.001()40(7.5)453(84.8)41(7.7)78(7.3)194(18.2)796(74.5)0.001()521(97.6)3(0.6)10(1.9)729(68.3)15(1.4)324(30.3)0.001349(65.4)185(34.6)637(59.6)431(40.3)0.0370CharlsonComorbidityScore)12-34-6≥7ADE3.5%(95%CI3.2%-3.7%)ADEADECharlsonComorbidityScore8ADEEinarson1966-1989ADE4.9%(0.2%-21.7%)1964-199539ADE4.7%ADEADEtypeAADE2.4%JAMA1998;279:1200-5AnnPharmacother1993;27:832-40ADEADEADE(polypharmacy)ADEADEADEADEADEADE9ADEinter-ratervaraibilityκ77%Naranjoscore()recallbiasADEADE()ADEADEADEADE3.5%Thankyouforyourattention!