10省市抗精神病药使用现况的调查

Antipsychotic drug patterns of schizophrenia in China: a cross-sectioned study

目的 调查中国10省市精神药物治疗精神分裂症的使用现状。方法 按人均国内生产总值将各省分为五个经济发展等级,以一定的抽样比例,选择10个省市的46家精神疾病专科医院或综合医院精神科的4779例住院和门诊精神分裂症患者,于2002年5月20-24日用自制调查问卷进行精神分裂症药物治疗的现况调查。结果 (1)在4779例患者中,门诊为1969例(41.20％),住院为2810例(58.80％)。与门诊患者比较,住院患者中的男性患者比例高、年龄大、病程长、公费医疗比例高(均P<0.01)。(2)使用频率在前六位的药物依次是氯氮平、利培酮、舒必利、氯丙嗪、奋乃静和氟哌啶醇。换算为氯丙嗪等效剂量后,治疗剂量为12.5-4125 mg/d,平均(365±253)mg/d。其中住院患者的使用剂量[(409±274)mg/d]高于门诊患者[(300±201)mg/d;F=223,P<0.01]。(3)2617例次(54.99％)使用典型抗精神病药,2940例次(61.78％)使用非典型抗精神病药(包括氯氮平在内)。312例接受长效抗精神病药。3523例(74.03％)接受单一抗精神病药治疗,1236例(25.97％)联合使用2种及其以上抗精神病药。(4)常见的合并治疗药物有抗胆碱能药、β-受体阻断剂、苯二氮(?)类药、抗抑郁药和心境稳定剂。结论 国内精神分裂症药物处方方式逐渐以非典型抗精神病药占主流,经济负担和患者的症状?

Objective To uncover the antipsychotic drug use patterns for treating schizophrenia in China and analyze the influence factors. Methods Ten provinces and Municipal cities were selected according to the publishing CEID data of GDP (2000) by State Statistics Bureau and the same sampling ratio of each economic level. The investigation was conducted during 20th-24th, May 2002, using the retested and revised self-compiled questionnaire. Results The total number of sample was 4 779. Antipsychotic medication most frequently prescribed was clozapine, subsequently were risperidone, sulpiride, chlorpromazine,perphenazine and haloperidol. The mean chlorpromazzine equivalent dosage was (365±253)mg/day (range of 12. 5-4 125 mg/d). 74. 03% of the patients were treated with mono-pharmacy, in which the atypical drugs, including clozapine accounting for 61. 78% (vs. 54. 99% for typical drugs) . The common concomitant medications were anticholinergic agents, benzodiazepine, β-receptor blockades, antidepressants and mood stabilizers. Main factors affecting the antipsychotic medication use patterns were the economic status and symptoms of patients. For typical drugs displaying wider spectrum of effects, those who experienced the affection symptoms would like to be prescribed atypical drugs. Conclusion Atypical drugs are gradually the major to treat schizophrenia in China, and the antipsychotic drug use patterns are greatly affected by the economic burden and clinical profile of patients.