20年间精神病住院患者的临床诊疗变迁

目的为了探讨近20年来精神病专科医院中住院患者的分布及相关的药物治疗变化趋势。方法通过病例资料检索方法分别抽取1991年、2000年及2009年在杭州市第七人民医院住院治疗的全部病例资料。结果共获得病例资料5635例，精神分裂症在各年度中的收治比例无显著差异，占所有精神障碍患者的半数以上（55．04％）；心境障碍仅次于精神分裂症，占所有疾病数的16．24％，在2000和2009年度中收治比例略低于1991年（P=0．002）；精神药物治疗方面的变化主要表现为新一代的抗精神病药物应用显著增多（1991，2000，2009年度分别为29．95％，50．78％，75．28％），各类精神药物的联用比例逐渐升高（各年度分别为54．42％，55．43％，70．52％）。结论近20年来精神分裂症仍然是精神病专科医院中住院治疗的主要对象，心境障碍住院患者的减少趋势可能与治疗学变化有关，新一代抗精神病药物的临床优势和药物治疗的多元化倾向正在被越来越多的临床医师所接受。

Objective The aims of this study was to investigate the variations of psychiatric in - patients＇ clinical diagnosis and treatment in order to explore its discipline and tendency. Method We drew off in -patients＇ cases in 1991, 2000 and 2009 of the Seventh People＇s Hospital of Hangzhou, with the method of case data searches. Result ①The study was conducted on 5635 cases of psychosis, the proportion of receiving and curing schizophrenia is relatively stable, it divines more than half（55.04% ） of all the patients. ②Mood disorders to 16. 24% ranked only second to schizophrenia, it consisted 16. 24% of all the diseases, the scale of 2000 and 2009 was less than 1991 a little（ P = 0. 002 ）. ③Change of the use of psychotropic drugs was mainly for the following two aspects. First, more and more doctors chose to use second -generation antipsychotic drugs（29. 95% ,50. 78% and 75.28% in year of 1991,2000 and 2009 separately）. Second, combination was more and more common （ 54.42% , 55.43 % and 70. 52% separately ）. Conclusion Schizophrenia remains the prime target of specialized hospital of mental disease in late twenty years, and,the trend of dropping of in - patients with mood disorder may concerning with therapeutic change, second - generation autipsychotic drugs＇ clinical superiority and diversification tendency of medical treatment are accepted by more and more clinicians.