精神分裂症老年患者服药依从性和血药浓度检测的意义

Compliance and antipsychotics plasma levels monitoring in the elderly patients with schizophrenia

目的 探索精神分裂症老年患者服用抗精神病药的依从性与血药浓度的关系及其临床意义。方法 观察 180例门诊中精神分裂症老年患者 ,其中单一服用氯丙嗪 5 8例、奋乃静 6 5例、氯氮平 4 0例、氟哌啶醇 17例。患者于入组后 2周和 3个月末分别检测血药浓度 ,评定其服药依从性、疗效和副反应。结果 应用氯丙嗪、奋乃静或氯氮平者在剂量相仿时 ,其血药浓度为完全依从者高于部分依从者 ,部分依从者高于不依从者 (F检验 ,P <0 0 1)。完全依从者的血药浓度与剂量呈显著性正相关 (Pearson检验 ,r=0 4 3～ 0 6 2 ,P <0 0 5或 <0 0 1)。血药浓度过低者的痊愈 +显著进步率为 5 1 2 % ,远低于血药浓度中 (72 2 % )高 (70 8% )者。血药浓度过高者的副反应发生率达 4 4 6 % ,明显高于血药浓度中 (2 5 0 % )低 (2 3 3% )者。结论 服药依从性与疗效密切相关 ,精神分裂症老年患者的服药依从性评估和血药浓度检测非常重要。

Objective To explore the relationship between compliance and plasma level of antipsychotics its clinical significance in the elderly schizophrenics Methods The compliance, plasma level of antipsychotics and therapeutic efficacy and side effect of 180 elderly cases of outpatients with schizophrenia who took one of following antipsychotics: chlorpromazine(58), perphenazine(65), clozapine(40)or haloperidol(17), were measured at the end of two weeks and three months in the treatment Results While the patients took similar prescribed doses of those drugs (chlorpromazine, perphenazine or clozapine), the plasma drug levels in the group of complete compliance were higher than that of noncompliance ( F test, P <0 01) The plasma drug levels were well correlated with daily dosage in the group of complete compliance (Pearson test, r =0 43-0 62, P <0 05/0 01) The recovery and the excellent effective rate of the patients with lower plasma level were 51 2%,which was far less than 71 5% of the rate of patients with middle or high plasma drug level And the side effects rate of the patients with the higher plasma drug level reached 44 6%,which was obviously higher than 24 2% of the rate of patients with middle or high plasma drug level Conclusion It is very important to evaluate the compliance and monitor the plasma drug level in treating of elderly shizophrenics with antipsychotics