精神病患者猝死的相关因素分析

Correlated factors of sudden death in psychotic inpatients

目的 探讨精神病患者猝死的相关因素。方法 选取 1997年 1月至 2 0 0 1年 12月在北京回龙观医院住院治疗中发生猝死的 6 5例精神病患者作为猝死组 ,以 2 0 0 2年 2月 2 0日所有在院的 110 7例精神病患者作为对照组。收集两组病例的主要人口学资料 (年龄、性别、精神障碍种类和病程 )和主要临床资料 (如合并躯体疾病种类、心电图特征、QTc间期、抗精神病药种类及剂量、合并其他精神药物的种类及剂量 ,主要不良反应等 ) ;对猝死组收集死因的临床判断及任何可能与猝死有关的资料。结果 (1)猝死组与对照组患者在抗精神病药剂量及QTc间期 (总体 )的差异均无显著性 (均P >0 0 5 )。 (2 )两组中接受氯氮平治疗者的QTc间期 [(0 36± 2 5 4 )ms]均长于非氯氮平治疗者 [(0 35±3 2 3)ms],差异有非常显著性意义 (P =0 0 0 ) ;其中 ,猝死组和对照组用氯氮平治疗者的QTc间期分别为 [(0 39± 1 31)ms和 (0 36± 2 4 6 )ms],未用氯氮平治疗者的QTc间期分别为 [(0 33± 3 2 3)ms和(0 35± 3 2 1)ms]。 (3)猝死组慢性起病者 (96 9% )多于对照组 (87 7% ;P =0 0 3) ,合并躯体疾病的比例 (89 2 % )高于对照组 (39 1% ;P =0 0 0 ) ,心电图异常率 (5 8 5 % )也高于对照组 (2 5 8% ;P =0 0 0 )。

ObjectiveTo explore relative risk factors of sudden death in psychotic inpatients. MethodsThe demographic and clinical data of 65 inpatients with sudden death and 1 107 live inpatients as controls from 1997 to 2001 in Beijing Huilongguan Hospital were retrospectively collected and analyzed. The clinical data mainly included the co-morbid physical disease, type and dosage of antipsychotics, electrocardiogram (ECG) QTc interval, side effects of antipsychotics and so on. The antipsychotic use was given special attention in order to find whether there was a relationship between antipsychotics and sudden death. ResultsThe co-morbid rates of physical disease (89.2%) and ECG abnormality (58.5%) were significant higher in died patients than in controls ( P <0.01). Clozapine could significantly prolong QTc interval than other antipsychotics. ConclusionCo-morbid physical diseases, ECG abnormality, and clozapine treatment may be the risk factors of sudden death in psychotic patients.