摘要
目的 研究海淀区精神病患者常用的8种抗精神病药物的血药浓度监测结果,供我院住院和海淀区各社区服药精神病患者参考,为个体化、合理化用药提供依据.方法 将北京市海淀区心理康复医院2023年1月至12月所有进行利培酮、喹硫平、氯氮平、奥氮平、氯丙嗪、阿立哌唑、氨磺必利及氟哌啶醇治疗药物监测(therapeutic drug monitoring,TDM)的原始数据汇总,分析住院和海淀各社区服药精神病患者的用药分布、多重用药率、治疗窗情况以及性别年龄与药物浓度之间的关系等.结果 8种抗精神病药物TDM结果所示,利培酮(26.3％)、奥氮平(21.6％)、氯氮平(21.0％)在抗精神药物用药人群中使用频率最高;抗精神药物多重用药率为19.8％;住院患者奥氮平、氟哌啶醇血药浓度在治疗窗范围内的比例较高,均大于65％;除氨磺必利外,住院患者利培酮、喹硫平、氯氮平、奥氮平、氯丙嗪、阿立哌唑及氟哌啶醇在治疗窗范围内的比例均高于社区患者;非参数Mann-Whitney U检验结果显示,住院患者利培酮与9-羟利培酮、氯氮平与去甲氯氮平、奥氮平的血药浓度女性均高于男性,且差异有统计学意义(P＜0.05);住院患者利培酮与9-羟利培酮血药浓度与年龄的结果显示60岁及以上老年患者血药浓度低于60岁以下患者,且差异具有统计学意义(P＜0.05);住院患者氯氮平与去甲氯氮平血药浓度与年龄的结果显示不同年龄段血药浓度比较差异无统计学意义(P＞0.05);住院患者奥氮平血药浓度与年龄结果显示,60岁及以上老年患者血药浓度高于60岁以下患者,且差异具有统计学意义(P＜0.05).结果 在临床实践中应重视精神病患者的血药浓度监测,密切结合TDM结果及时调整药物剂量,避免可能出现的治疗不足和药物使用不当情况,保障患者临床用药有效、安全.
Abstract
Objective To study therapeutic drug monitoring results of eight commonly used antipsychotic drugs for psychiatric patients in Haidian District,and to provide references for inpatients in our hospital and psychiatric patients taking medication in various communities in Haidian District,and to further provide a knowledge basis for individualized and rational medication usage.Methods We collected and summarized datasets of therapeutic drug monitoring(TDM)conducted by Beijing Haidian Psychological Rehabilitation Hospital from January to December,2023,including risperidone,quetiapine,clozapine,olanzapine,chlorpromazine,aripiprazole,amisulpride and haloperidol.A retrospective analysis was conducted for medication distribution,reuse rate,treatment window status,and the relationship between gender,age,and drug concentration among inpatients and psychiatric patients taking medications in various communities in Haidian District.Results According to TDM results of 8 antipsychotic drugs,risperidone(26.3％),olanzapine(21.6％),and clozapine(21.0％)had the highest frequency of use among antipsychotic drug users;The rate of multiple use of antipsychotic drugs was 19.8％;TDM results of olanzapine and haloperidol in hospitalized patients within the treatment window was relatively high,both exceeding 65％;Except for amisulpride,proportions of inpatients with risperidone,quetiapine,clozapine,olanzapine,chlorpromazine,aripiprazole,and haloperidol within the treatment window were higher than that of community patients;The results of the non-parametric Mann Whitney U test showed that TDM results of risperidone and 9-hydroxyrisperidone,clozapine and norclozapine,olanzapine in hospitalized patients were higher in females than in males(P＜0.05);The results of risperidone and 9-hydroxyrisperidone in hospitalized patients with age factor showed that TDM results in elderly patients aged 60 and above were lower than those in patients under 60 years old(P＜0.05);The results of clozapine and norclozapine in hospitalized patients with age factor showed no significant difference among different age groups(P＞0.05);Olanzapine in hospitalized patients showed that TDM results in elderly patients aged 60 and above was higher than that in patients under 60 years old(P＜0.05).Conclusion The current study suggests that in clinical practice,attention should be paid of TDM in psychiatric patients,and timely adjustment of drug dose should be closely combined with the results of TDM,so as to avoid potential insufficient treatment and improper drug use,and to ensure the effective and safe clinical drug use.
维普
万方数据