某精神专科医院BZD药物联用现况与药物依赖情况分析

Analysis of the current status of BZD drug combination and drug dependence in a psychiatric hospital

目的探讨某精神专科医院苯二氮类(BZD)药物联用的现状及药物依赖风险,并提出改进监管策略。方法提取某精神专科医院2019~2021年住院的患者7666例,统计分析含BZD药物医嘱患者的年龄、性别分布情况以及BZD药物联合使用其他精神科药物情况。筛选住院治疗期间曾合并使用BZD药物+氯氮平4周及以上且≥18周岁的患者452例,根据氯氮平使用剂量分为研究组(常规剂量,328例)和对照组(低剂量,124例),比较两组人口学资料及BZD药物依赖自评量表(BDEPQ)评分。结果2019~2021年出院患者共开具含BZD药物医嘱3894条(按同期出院人次算),其中男2126条(54.60%),女1768条(45.40%),女性实际合并使用BZD药物比例73.45%(1768/2407)高于男性的40.43%(2126/5259)。年龄方面,BZD药物医嘱用药人群主要集中在31~60岁,占比69.77%;≤30岁仅占医嘱总数的12.97%,>60岁占17.26%。对2019~2021年全院7666例出院患者的长期医嘱数据进行分析,BZD药物联合使用其他精神科治疗的药物主要包括氯氮平、奋乃静等11种,其中使用率最高的为氯氮平,占医嘱总数的39.00%。因氯氮平本身具有较强的镇静作用,且在医院的精神科治疗中使用量大、合并BZD药物频率高,本研究中选择氯氮平作为BZD药物联合用药的代表性药物。经过近3年来不断加强联合用药监管和调整治疗方案,已有部分患者在BZD药物合并用药时调整治疗方案,停用BZD药物或相应调减合并用药的剂量,其中调减剂量的医嘱数占所有医嘱总数的比例为26.83%。研究组排除因认知力差、不配合等原因无法完成BDEPQ问卷访谈23例,最终入组305例;对照组排除因认知力差、不配合等原因无法完成BDEPQ问卷访谈11例,最终入组113例。统计分析结果显示,两组间性别、年龄、病程、BZD药物用量比较均无显著差异(P>0.05);研究组氯氮平用量(360.95±175.95)mg/d高于对照组的(59.51±15.06)mg/d,有显著差异(P<0.05)。研究组受试患者中不依赖者125例,可疑依赖者145例,依赖者35例;对照组受试患者中不依赖者75例,可疑依赖者36例,依赖者2例;两组间药物依赖情况比较有显著差异(P<0.05)。研究组BDEPQ评分(23.91±9.58)分高于对照组的(19.24±8.99)分,有显著差异(P<0.05)。结论BZD药物与抗精神分裂症药物氯氮平合用会增加药物依赖风险,应相应调减氯氮平剂量,临床应改善治疗方案和改进监管策略。

Objective To explore the current situation of benzodiazepine(BZD)drug combination and the risk of drug dependence in a psychiatric hospital,and put forward improved supervision strategies.Methods 7666 patients hospitalized in a psychiatric hospital from 2019 to 2021 were selected to statistically analyze the age and gender distribution of patients with BZD drug-containing medical prescriptions,as well as the combined use of BZD with other psychiatric drugs.452 patients who had used BZD drugs+clozapine in combination for 4 weeks or more during hospitalization and were≥18 years old were screened and divided into a study group(regular dosage,328 cases)and a control group(low dosage,124 cases)according to the dosage of clozapine use,and the demographic data and Benzodiazepine Dependence Questionnaire(BDEPQ)scores of the two groups were compared.Results A total of 3894 medical prescriptions containing BZD drgus were issued for patients discharged from hospitals from 2019 to 2021(based on the number of discharges during the same period),of which 2126 prescriptions(54.60%)were for men and 1768(45.40%)prescriptions were for women,and the proportion of women's actual combined use of BZD drugs was 73.45%(1768/2407),which was higher than 40.43%(2126/5259)of men.In terms of age,BZD drug prescribing population was mainly concentrated in 31-60 years old,accounting for 69.77%;≤30 years old accounted for only 12.97%of the total number of medical records,and>60 years old accounted for 17.26%.Long-term medical order data of 7666 discharged patients in our hospital from 2019 to 2021 were analyzed.BZD drugs combined with other psychiatric drugs mainly included 11 drugs such as clozapine and perphenazine,among which clozapine had the highest usage rate,accounting for 39.00%of the total number of medical orders.Because of the strong sedative effect of clozapine itself,and the large amount of use in psychiatric treatment in hospitals and the high frequency of combining BZD drugs,clozapine was chosen as a representative drug for the combination of BZD drugs in this study.After nearly 3 years of strengthening the supervision of combined medication and adjusting the treatment plan,some patients have already adjusted the treatment plan when combining BZD drugs,discontinued BZD drugs or reduced the dose of combined medication accordingly,in which the number of medical prescriptions for dose reduction accounted for 26.83%of the total number of all medical orders.The study group excluded 23 cases who could not complete the BDEPQ questionnaire interview due to poor cognitive ability,uncooperation and other reasons,and finally enrolled 305 cases;the control group excluded 11 cases who could not complete the BDEPQ questionnaire interview due to poor cognitive ability,non-cooperation and other reasons,and finally enrolled 113 cases.Statistical analysis showed that there was no significant difference in gender,age,disease duration,and BZD drug dosage between the two groups(P>0.05).Clozapine dosage of(360.95±175.95)mg/d in the study group was higher than(59.51±15.06)mg/d in the control group,with significant difference(P<0.05).There were 125 non-dependents,145 suspected dependents and 35 dependents in the study group of subject patients;there were 75 cases of non-dependents,36 cases of suspected dependents and 2 cases of dependents among the subject patients in the control group.There was a significant difference in the comparison of drug dependence between the two groups(P<0.05).The BDEPQ score of(23.91±9.58)points in the study group was higher than(19.24±8.99)points of the control group,which was significantly different(P<0.05).Conclusion The combined use of BZD drug and anti-schizophrenia drug clozapine increases the risk of drug dependence,so the dose of clozapine should be reduced accordingly,and clinical treatment and regulatory strategies should be improved.