住院精神分裂症药物治疗方案的年代变迁和地区差异

发布时间：2018-08-06 14:25

【摘要】：目的：调查不同年代和不同地区住院精神分裂症患者的药物治疗情况，包括治疗方案、抗精神病药物种类和剂量，联合用药和合并用药情况，了解近30年以来抗精神药物使用变迁，为临床合理用药提供依据。方法：采用回顾性研究设计，从三家不同地区的精神专科医院病案室中分别抽取1980s、、1990s、2000s首次入院的精神分裂症患者的病历各50份，并采用自制调查表调查诊断及用药情况。使用SPSSl6.0统计软件对结果进行统计描述和统计分析。统计分析方法：卡方检验、描述性统计分析、方差分析，P＜0.05为差异有统计学意义。结果：1.不同年代之间联合用药组之间（第一代抗精神病药（FGA）+FGA组，第二代抗精神病药（SGA）+FGA组，SGA+SGA组）比较差异显著性明显（χ2=125.8，P=0.000），不同年代之间抗胆碱能药比较（χ2=16.829，P=0.000），抗焦虑药比较（χ2=9.678，P=0.008），抗惊厥药比较（χ2=6.315，P=0.043）。把合并其他药物种类分成两组（大于等于2种，小于2种）比较发现差异性显著（χ2=8.235，P=0.016）。三个年代之间稳定后治疗剂量之间比较差异性不显著，而时点最高剂量在男女患者群体中均有逐年下降的趋势（p男=0.002，p女=0.041），关于不同年代男女之间稳定后治疗剂量的比较发现，2000s男女之间稳定后治疗剂量差异性显著，且男性高于女性（p=0.010）。 2.对三个地区之间联合使用抗精神病药物的比较发现：单一用药组与联合用药组（χ2=13.430，P=0.0010.05），联合用药方式（FGA+FGA组，SGA+FGA组，SGA+SGA组）比较（χ2=26.363，P=0.0000.05），有无合并其他用药组比较（χ2=40.200，P=0.0000.05），有无合并抗胆碱能药组比较（χ2=15.332，P=0.0000.05），有无合并抗焦虑药组比较（χ2=44.261，P=0.0000.05），有无合并抗惊厥药组差异显著性不明显（χ2=5.896，P=0.052），把合并其他药物种类分成两组（大于等于2种，小于2种）比较发现差异性显著（χ2=41.727，P=0.0000.05）。三个地区之间稳定后治疗剂量的比较差异性不显著，而C地区时点最高剂量高于A地区和B地区，差异显著性明显（p=0.0300.05），另外，男女性别之间用药剂量比较发现，C地区男女时点最高剂量的比较差异性显著（p=0.000，男女），A地区和C地区男女稳定后治疗剂量的比较差异性显著（p=0.012，p=0.011，且均男女）。结论：1.三个年代之间联合用药和合并用药方式都发生了显著改变，非典型抗精神病药物使用频率和合并使用抗焦虑和抗惊厥药物频率呈递增趋势，，最高用药剂量呈下降趋势。2.三个地区之间的比较发现，C地区使用第二代抗精神病药物的比例最高，B地区次之，A地区最少；在合并其他用药方式中，C地区合并抗胆碱能药以及抗焦虑药的频率高于B地区和A地区；C地区合并两种或两种以上用药的现象比A地区和B地区更普遍；
[Abstract]:Objective: to investigate the drug treatment of inpatients with schizophrenia in different ages and regions, including treatment regimen, types and doses of antipsychotic drugs, combined and combined use. To understand the changes in the use of antipsychotic drugs in recent 30 years and to provide evidence for rational use of drugs in clinic. Methods: a retrospective study design was used to collect 50 medical records of schizophrenic patients who were first admitted to hospital in 1980 s or 1990 s / 2000s from the medical record rooms of three different regions of psychiatric hospitals, and to investigate the diagnosis and medication of schizophrenia by self-made questionnaire. SPSSl6.0 statistical software is used to describe and analyze the results. Statistical analysis methods: chi-square test, descriptive statistical analysis, ANOVA (P < 0.05) were statistically significant. The result is 1: 1. Between the different age groups (FGA) FGA group, first generation antipsychotic drug), There were significant differences between the second generation antipsychotics (SGA) FGA group and the control group (蠂 2 + 125.8% P0. 000), the comparison of anticholinergic drugs (蠂 2 + 16. 829 P0. 000), the comparison of anti anxiety drugs (蠂 2 + 9. 678% P0. 008), and the comparison of anti convulsion drugs (蠂 2 + 6. 315 P0. 043). There were significant differences between the two groups (> 2, less than 2) (蠂 2 + 8. 235%, P < 0. 016). There was no significant difference between the stable post-treatment doses in the three decades. However, the highest dose at the time point decreased year by year in both male and female patients (p male 0.002p female 0.041). The comparison of stable post-treatment dose between male and female in different ages showed that there was a significant difference in stable post-treatment dose between male and female in 2000s. And the male was higher than the female (p0.010). The comparison of antipsychotic drugs used in three regions was found: single drug group and combination drug group (蠂 2 + 13.430), (FGA FGA group (P < 0. 0010.05) and (FGA FGA group (P < 0. 0000. 05), there were no other drugs (蠂 2 40.200), and there was no significant difference between the two groups (蠂 2, P < 0. 05, P < 0. 000), and the (FGA FGA group (P < 0. 0005). The comparison of anti-cholinergic drug group (蠂 ~ 2 + 15.332P ~ (0.0000.05), the group with or without an anti-anxiety drug (蠂 ~ (2 +) ~ (44.261) (蠂 ~ (0.0000.05), and the group with or without anticonvulsant drugs were not significant (蠂 ~ (2) ~ (5.896) P ~ (0.052), and the other drugs were divided into two groups (> 2), and no significant difference was found between the two groups (> 2). There were significant differences between the two species (蠂 2: 41.727 P 0.0000.05). There was no significant difference in the treatment dose between the three regions after stabilization, but the highest dose at time point in C area was higher than that in A area and B area, and the difference was significant (p0. 0300.05). The results showed that there was a significant difference between male and female in the highest dose at the time point between male and female (p0. 000, male and female). There was significant difference between male and female in stable treatment dose in area A and C (p0. 012, p0. 011, and both male and female). Conclusion 1. During the three decades, the combination and combination of drugs changed significantly, the frequency of atypical antipsychotic drugs and the frequency of combined use of anti-anxiety and anticonvulsant drugs showed an increasing trend, and the highest dosage of antipsychotics showed a downward trend of 0.2. The comparison among the three regions showed that the second generation of antipsychotic drugs was the highest in area C and the lowest in area B, followed by area A. The frequency of combination of anticholinergic drugs and antianxiety drugs in area C was higher than that in area B and area A in combination with two or more kinds of drugs.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R749.3

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