门诊与住院精神分裂症患者用药分析
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摘要
目的:
了解我院门诊与住院精神分裂症患者药物治疗的合理性,从而进一步规范我院的治疗手段,提高治疗效果,减少不良反应。
材料与方法:
1.采取自设计的调查表对2009年初次在我院门诊就诊与首次入住我院的精神分裂症患者的病历进行调查。
2.采用WHO药物统计合作中心设定的限定日剂量(DDD)计算我院抗精神病药的用药频度(DDDs)、药物利用指数(DUI)。
3.统计分析:调查数据应用EXCEL2003和SPSS13.0统计学软件进行统计分析。符合正态分布的数据应用均数±标准差(x±S)表示,进行两独立样本的t检验;若数据不符合正态分布则进行两独立样本的秩和检验;两组数据为计数资料时,进行卡方分析。以P≤0.05为差别有显著性。
结果:
1.我院门诊精神分裂症患72.6%为单一用药,最常用的药物是奥氮平,住院患者53.4%为单一用药,最常用的药物是利培酮。单一用药疗效比较,住院组优于门诊组。
2.本次调查中联合用药率为38.3%,其中门诊组为27.4%,最常用的联合用药方案为奥氮平+利培酮;住院组为46.6%,最常用的方案为氯氮平+利培酮。住院组联合用药率显著高于门诊组,也高于国内外的调查研究。
3.本次调查结果显示,单一用药与联合用药的疗效比较无统计学意义。
4.门诊组的药物利用指数DUI≤1,住院组除阿立哌唑、奥氮平、洛沙平DUI略大于1,其余各抗精神病药DUI≤1。
5.门诊组有66.2%患者应用抗胆碱能药物,住院组有67.06%患者应用。门诊组患者有18.04%患者长期(>4周)应用苯二氮卓类药物,住院组患者有13.35%。
结论:我院门诊与住院精神分裂症患者用药结构倾向合理,但也存在不合理的现象。
Objective:
To investigate the clinical utilization of drugs for outpatients and inpatients with schizophrenia , so as to further regulate the rationality of our treatment method and improve therapeutic effect, as well as reduce adverse reactions.
Materials and methods:
1. Using the self-designed questionnaire to investigate the patients who went to our hospital for the first. time.
2. The outpatients and inpatients were analyzed with regard to DDDs , drug utilization index(DUI) and drug combination by using the defined daily dose (DDD) ,which were recommended by WHO Collaborating Center for Drug Statistic Methodology.
3. Data analysis: Data were presented as mean±?standard deviation ( x±S), and statistically analyzed by two independent samples t test with EXCEL 2003 and SPSS13.0, when normally distributed. Otherwise,nonparametric test wsa applied when two sets of data for the measurement data,using the Chi-square analysis. A level of P≤0.05 was accepted as statistically significant.
Results :
1.There were 72.6% of outpatients with schizophrenia used single kind of antipsychotic drugs , the most common drug used was Olanzapine ;53.4% of inpatients with schizophrenia used single kind of antipsychotic drugs ,the most common drug used was Risperidone . Comparison of single drug effects, in-patient group was better than out-group.
2.The survey was 38.3% in the combined treatment, including out-patient group was 27.4% and in-patient group was 46.6%. The most combination of out-patient group was Olanzapine with Risperidone,while of in-patient group was Clozapine whit Risperidone.
3. The survey results show that a single drug and combination therapy had no statistically significant effect.
4.The DUI of outpatients were all greater or equal to 1;while the DUI of most inpatients were greater or equal to 1,except Aripiprazole、Olanzapine and Loxapine.
5.There were 66.2% of outpatients used anticholinergic drugs which were 67.06% of inpatients. There were 18.04% outpatients who had been taken benzodiazepine for longer than 4 weeks, which were 13.35% of inpatients.
Conclusions:
The psychopharmacotherapies in our hospital were almost rational, but some improper phenomenon still existed.
了解我院门诊与住院精神分裂症患者药物治疗的合理性,从而进一步规范我院的治疗手段,提高治疗效果,减少不良反应。
材料与方法:
1.采取自设计的调查表对2009年初次在我院门诊就诊与首次入住我院的精神分裂症患者的病历进行调查。
2.采用WHO药物统计合作中心设定的限定日剂量(DDD)计算我院抗精神病药的用药频度(DDDs)、药物利用指数(DUI)。
3.统计分析:调查数据应用EXCEL2003和SPSS13.0统计学软件进行统计分析。符合正态分布的数据应用均数±标准差(x±S)表示,进行两独立样本的t检验;若数据不符合正态分布则进行两独立样本的秩和检验;两组数据为计数资料时,进行卡方分析。以P≤0.05为差别有显著性。
结果:
1.我院门诊精神分裂症患72.6%为单一用药,最常用的药物是奥氮平,住院患者53.4%为单一用药,最常用的药物是利培酮。单一用药疗效比较,住院组优于门诊组。
2.本次调查中联合用药率为38.3%,其中门诊组为27.4%,最常用的联合用药方案为奥氮平+利培酮;住院组为46.6%,最常用的方案为氯氮平+利培酮。住院组联合用药率显著高于门诊组,也高于国内外的调查研究。
3.本次调查结果显示,单一用药与联合用药的疗效比较无统计学意义。
4.门诊组的药物利用指数DUI≤1,住院组除阿立哌唑、奥氮平、洛沙平DUI略大于1,其余各抗精神病药DUI≤1。
5.门诊组有66.2%患者应用抗胆碱能药物,住院组有67.06%患者应用。门诊组患者有18.04%患者长期(>4周)应用苯二氮卓类药物,住院组患者有13.35%。
结论:我院门诊与住院精神分裂症患者用药结构倾向合理,但也存在不合理的现象。
Objective:
To investigate the clinical utilization of drugs for outpatients and inpatients with schizophrenia , so as to further regulate the rationality of our treatment method and improve therapeutic effect, as well as reduce adverse reactions.
Materials and methods:
1. Using the self-designed questionnaire to investigate the patients who went to our hospital for the first. time.
2. The outpatients and inpatients were analyzed with regard to DDDs , drug utilization index(DUI) and drug combination by using the defined daily dose (DDD) ,which were recommended by WHO Collaborating Center for Drug Statistic Methodology.
3. Data analysis: Data were presented as mean±?standard deviation ( x±S), and statistically analyzed by two independent samples t test with EXCEL 2003 and SPSS13.0, when normally distributed. Otherwise,nonparametric test wsa applied when two sets of data for the measurement data,using the Chi-square analysis. A level of P≤0.05 was accepted as statistically significant.
Results :
1.There were 72.6% of outpatients with schizophrenia used single kind of antipsychotic drugs , the most common drug used was Olanzapine ;53.4% of inpatients with schizophrenia used single kind of antipsychotic drugs ,the most common drug used was Risperidone . Comparison of single drug effects, in-patient group was better than out-group.
2.The survey was 38.3% in the combined treatment, including out-patient group was 27.4% and in-patient group was 46.6%. The most combination of out-patient group was Olanzapine with Risperidone,while of in-patient group was Clozapine whit Risperidone.
3. The survey results show that a single drug and combination therapy had no statistically significant effect.
4.The DUI of outpatients were all greater or equal to 1;while the DUI of most inpatients were greater or equal to 1,except Aripiprazole、Olanzapine and Loxapine.
5.There were 66.2% of outpatients used anticholinergic drugs which were 67.06% of inpatients. There were 18.04% outpatients who had been taken benzodiazepine for longer than 4 weeks, which were 13.35% of inpatients.
Conclusions:
The psychopharmacotherapies in our hospital were almost rational, but some improper phenomenon still existed.
引文
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[5]沈渔村.精神病学[M ].第五版.北京:人民卫生出版社, 2010:
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[24] Ai D,Roper TA,Riley JA.Dabdic ketoacidosis and clozop一in.Postgrad MedJ,1998,74:493—494.
[25]舒良.精神分裂症治疗指南[M] .北京:北京大学医学出版社, 2007: 35.
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[2] Gary R.1 2 atld 5 HTz receptor effects of antipsyehoties:bridging basic and clinical findings using PET[J_.J Chin Psychial1 v,l 0 )0,60(S'uppl 10):1 5 23.
[3] DEAN B,SCARR E.Antipsychotic drugs:evolving mech-anisms of action with impmved therapeutic benefits[J]Curr Drug Targets CNS Neurol Disord,2004,3(3):217—225.
[4] HOULTRAM B , SCANI . AN M . Care maps : atypical anti-psychotics introduction[J].Nurs Stand,2004,18(36):42～44.
[5]沈渔村.精神病学[M ].第五版.北京:人民卫生出版社, 2010:
[6] http://www.whocc.no/atc_ddd_index/
[7] National Collaborating Centre for Mental Health, Schizophrenia Core interventions in the treatment and management of schizophrenia in primary and secondary care,2002
[8]刘铁桥,李凌江,住院精神疾病患者药物治疗临床分析[J] ,左峰,陈卉,杨顺生,何继岳,全立新,临床精神医学杂志,2003, l3(9)
[9] Lindenmayer JP,Liu-Seifert H,Kulkarni PM etal.Medication nonadherence and treatment outcome in patients with schizophrenia or schizoaffective disorder with suboptimal prior response. J. Clin. Psychiatry 70(7),990–996 (2009).
[10] MIAN-YOON CHONG, md, phd ,Antipsychotic drug prescription for schizophrenia in East Asia: rationale for change,Psychiatry and Clinical Neurosciences (2004), 58,61–67
[11] Eugen Davids,Psychotropic drug prescription in a psychiatric university hospital in Germany,Progress in Neuro-Psychopharmacology & Biological Psychiatry 30 (2006) 1109– 1116
[12] Stahl SM. Essential Psychopharmacology, 2nd edn.Cambridge University Press, Cambridge, 2000.
[13] Lieberman JA. Atypical antipsychotic drugs as a first linetreatment ofschizophrenia: a rationale and hypothesis. J.Clin. Psychiatry 1996; 57 (Suppl. 11): 68–71. [14 ]王祖新.现代精神疾病治疗学[ M] .济南:山东科学技术出版社, 1997. 232
[15]司天梅,舒良,于欣,等. 10省市抗精神病药使用现状的调查[ J] .中华精神科杂志, 2004, 37( 3) : 152.
[16] Corrado Barbui, Michela Nose, Maria Angela Mazzi,Determinants of first-and second-generation antipsychotic drug use in clinically unstable patients with schizophrenia treated in four European countries , International Clinical Psychopharmacology 2006, Vol 21 No 2.
[17]Istvan Bitter,Antipsychotic Antipsychotic prescription patterns in outpatient settings: 24-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study,European Neuropsychopharmacology (2008) 18, 170–180.
[18]李玉平,韩春芳.精神分裂症患者药物治疗情况分析[J] .中国医疗前沿, 2009, 4( 4) : 100.
[19] Michael J. Sernyak, MD.Robert A.Rosenheck,MD.,Antipsychotic Use in the Treatment of Outpatients With Schizophrenia in the VA From Fiscal Years 1999 to 2006,PSYCHIATRIC SERVICES May 2008 Vol. 59 No. 5.
[20] Samantha A.Hollingworth ,Dan J.Siskind, Patterns of antipsychotic medication use in Australia 2002–2007,Australian and New Zealand Journal of Psychiatry 2010; 44:372–377.
[21]谢经敏,彭德福.住院精神分裂症患者抗精神病药物使用情况调查[J],重庆医学,2010,39(6):734
[22] Lieberman JA. Atypical antipsychotic drugs as a ?rst linetreatment of schizophrenia: a rationale and hypothesis. J.Clin. Psychiatry 1996; 57 (Suppl. 11): 68–71.
[23] Disayavanish C,Srisurapanom M,Udomratn P,et a1.Guideline for the pharmacotherapy of treatment—resistant schizophrenia[J].J Med Assoc Thai,2000,83(6):579—589.
[24] Ai D,Roper TA,Riley JA.Dabdic ketoacidosis and clozop一in.Postgrad MedJ,1998,74:493—494.
[25]舒良.精神分裂症治疗指南[M] .北京:北京大学医学出版社, 2007: 35.
[26] Turbay D, Lieber man J, Alper CA, et al. Tumor necrosis face to constellation polymorphismand clozapine induced agranulocytosis in two different ethnic groups. Blood, 1997, 89( 11) : 4167~ 4174
[27]疑有较重不良反应被通报感冒通等9种药要慎用.当代健康报, 2002. 9. 19. 1版
[28]李华芳,顾牛范.新型抗精神病药:利培酮.上海精神医学, 1997, 9( 1) : 47
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