住院精神病人猝死危险因素分析

目的探讨住院精神病人猝死的危险因素与临床特征,为降低其猝死发生率提供依据。方法对1998-2008年内4所精神病专科医院住院期间发生猝死的全部病例与随机抽取的同期住院的非猝死患者的临床资料进行回顾性调查分析。将所有因素进行比较及单因素分析,差异有统计学意义的因素进行logistic回归分析。结果两组联合用药、抗精神药种类、抗抑郁药种类、合并躯体疾病、心电图异常、入院时状态差的构成比差异有统计学意义(P0.05或0.01)。Logistic回归分析,合并躯体疾病、心电图异常、联合用药、传统抗精神病药(舒必利针剂、氯丙嗪、氯氮平)、入院时状态差为高危因素;新型抗精神病药、选择性5-羟色胺再摄取抑制剂(SSRIs)为保护因素。结论本研究结果表明,10年内猝死发生率为1.5‰。男性比女性多。晨3与7时左右为猝死高峰期。关注住院精神病人躯体疾病、入院时状态及心电图变化等;尽量用新型少用传统抗精神病药;尽量用SSRIs少用三环类抗抑郁剂(TCAs);最好单一用药,可减少猝死的发生。

Risk factors of sudden death in inpatients with mental disorders in mental hospitals

Objective To investigate the risk factors and their characteristics of sudden death in inpatients with mental disorders.Methods A case control study was performed to collect the clinical data of all inpatient cases with sudden death in 4 mental hospitals from 1998-2008.A logistic regression model was used to analyze the risk factors of the cases.Results The incidence rate of sudden death was 1.5‰ in inpatients with mental disorders for the period of time.The cases happened more in male than in female.The daily peak time of sudden death appeared between 3∶00-7∶00 AM.The risk factors of sudden death included combination of drugs from antipsychotics and antidepressants,with comorbid somatic diseases,the abnormality of electrocardiogram（ECG）and bad health status of patients（P0.05 or 0.01）.However,the model suggested that new type antipsychotics and SSRIs were protective factors.Conclusion Additional attention should be given to inpatients with comorbid somatic diseases,ECG abnormalities and bad health status.New antipsychotics and SSRIs were preferable to traditional ones.