1986年至2006年间4个年份唐山市精神分裂症住院患者抗精神病药物使用变化趋势

Antipsychotic drug use in inpatients with schizophrenia in tangshan region during 1986～2006

目的分析近20年精神分裂症住院患者抗精神病药物治疗种类和剂量变化趋势。方法调查1986年、1996年、2001年和2006年4个年份在唐山市6所精神病院出院的2718例精神分裂症患者的3195份住院病历,用专门设计的调查表记录患者的社会人口学资料、疾病特征以及患者出院时药物治疗信息。结果①治疗药物的变化:1986年、1996年、2001年和2006年最常使用的抗精神病药物分别是第一代抗精神病药物、氯氮平、氯氮平、除氯氮平外的第二代抗精神病药物,使用率分别为93.8%(396/422)、45%(285/634)、59.9%(557/930)、51.6%(623/1206)。2006年氯氮平使用率达35.7%(431/1206)。4个年份间患者出院时合并使用2种以上抗精神病药物治疗的比例呈升高趋势(趋势2=99.10,P<0.001),从1986年的10.43%(44/422)渐升至2006年的26.29%(317/1209)。②药物剂量变化:4个年份出院时患者服用抗精神病药物的氯丙嗪等效日剂量组间比较差异有统计学意义(Kruskal-Wallis2=43.32,P<0.001),4个年份的出院患者日服药剂量随年份增长而呈下降趋势(SpearmanR=-0.13,P<0.001);抗精神病药的单一治疗日剂量低于合并治疗,差异有统计学意义(Kruskal-Wal-lis2=14.23,P<0.001)。③多元回归分析表明,患者出院时服用抗精神病药物的氯丙嗪等效剂量与抗精神病药物联合治疗(b=163.86,P<0.001)、住院天数(b=25.76,P<0.001)呈正相关;与使用第二代抗精神病药物(b=-114.92,P<0.001)、发病年龄(b=-3.87,P<0.001)呈负相关。结论近20年第二代抗精神病药物已逐渐成为抗精神病治疗的主要用药,抗精神病药合并治疗的比例增加。临床实践中应考虑到氯氮平一直保持较高使用率的利弊和合并用药可能带来的药物不良反应。

Objective To evaluate the trends of various antipsychotic drugs use rates and daily doses in hospitalized patients with schizophrenia at the time of discharge over the past two decades. Methods Hospital medical records of schizophrenic inpatients who discharged from six psychiatric hospitals in Tangshan region within 1986, 1996, 2001, and 2006 were reviewed. 3195 hospital medical records of 2718 patients with schizophrenia were coded. Trained investigators coded demographic and clinical characteristics and prescription information of the patients at the time of discharge with a specially designed form. Results First generation antipsychotics （FGAs） were the most common prescribed drugs in schizophrenic inpatients in 1986 （93. 8% , 396/422）, and clozapine was the most common used drug in 1996（45% ,285/ 634 ） and in 2001 （ 59. 9%, 557/930 ）. However, in 2006, second generation antipsychotic （SGAs） excluding clozapine became most common used drugs with total use rate over 50% （623/1206） , and clozapine became the second common used antipsychotic drug with the use rate of 35.7% （431/1206）. The proportion of combined use of antipsychotic durgs showed a increasing trend, from 10. 43% （44/422） in 1986 to 26. 29% （317/1209） in 2006 （ linear by linearZ 2 ~ 99. 10,P 〈 0. 001 ）. The daily chlorpromazine equivalent dose of antipsychotics taken by schizophrenic patients at the time of discharge had been decreasing from 1986 to 2006 （ Spearman R = - 0. 13, P 〈 0. 001 ） and chlorpromazine equivalent dose on combined antipsychotic drug use at the time of discharge was higher than that on single antipsychotic durg use （ Kruskal-WallisZ 2 = 14. 23, P 〈0. 001 ）. Multivariate analysis showed that combined antipsyehotic drug use（ b = 163.86 ,b＇ =0. 25 ,t = 14. 47 ,P 〈 0. 001 ） ,longer duration of hospital stay in day （ b = 25.76, b＇ = 0. 10, t = 5.52, P 〈 0. 001 ） were associated with higher antipsyehotie daily dose while prescription of SGAs （ b = - 114. 92, b＇ = - 0. 12, t = - 10. 44, P 〈 0. 001 ） and later onset age （b = -3.87, b＇ = -0. 12, t = -7.11, P 〈 0. 001 ） have a association with lower daily doses of antipsychotic drugs. Conclusions SGAs has been becoming most common used antipsychotics in Tangshan region. The proportion of combined use of antipsychotic drugs has been increosing. Serious consideration should be taken both on risk benefit ratio of clozapine use and on potential side effect caused by combined use of antipsychotic drugs in clinical practice.