慢性失眠患者超说明书范围使用非典型抗精神病药物情况

目的调查非典型抗精神病药（atypical antipsychotics,AAPs）在门诊慢性失眠患者中8年前后的使用情况及对苯二氮卓类药物（benzodiazepines,BZDs）的影响,为临床用药提供依据。方法选择2012年（135例）与2005年（113例）在门诊就诊的慢性失眠患者进行AAPs及BZDs使用情况的回顾性调查。结果 2005年患者组BZDs使用率（89.4%）、使用时间[（8.21±3.76）月]、使用剂量[（12.32±3.43）mg/d]高于2012年患者组[分别为79.3%、（5.46±2.05）月、（5.36±2.87）mg/d）],AAPs使用率（15.9%）、依赖综合征发生率（11.1%）低于2012年患者组（分别为42.2%、40.4%）,差异均有统计学意义（P〈0.05,P〈0.01）。2012年使用AAPs患者组的BZDs使用剂量[（3.42±3.11）mg/d]、长期使用率（39.1%）低于无AAPs组[分别为（6.82±3.32）mg/d、60.7%],差异有统计学意义（P〈0.05）。结论 AAPs在门诊慢性失眠患者中的使用有明显增加趋势,有助于减少BZDs的不合理使用,但其自身也存在不合理使用及依赖综合征的情况,需要引起高度重视。

The off-label uses of atypical antipsychotics in patients with chronic insomnia

Objective To investigate the off-label uses of atypical antipsychotics（AAPs） for 8 years and the influence of AAPs on benzodiazepines（BZDs） application in patients with chronic insomnia and to provide the base for clinical utilization. Methods The subjects with chronic insomnia were investigated retrospectively for AAPs and BZDs application, and 248 cases were divided into 2 groups： 135 cases from 2012 served as 2012 group and 113 cases from 2005 served as 2005 group. Results The rate（89.4%）, duration [（8.21±3.76） months] and dose [（12.32±3.43） mg/d] of BZDs application in 2005 group were significantly higher than those [79.3%,（5.46 ±2.05） months and（5.36 ±2.87） mg/d] in 2012 group, the AAPs application rate（15.9%） and dependence syndrome rate（11.1%） in 2005 group were significantly lower than those（42.2% and 40.4%） in 2012 group（P〈0.05 or P〈0.01）. BZDs dose [（3.42±3.11） mg/d] and long application rate（39.1%） in 2012 group with AAPs were significantly lower than those [（6.82±3.32） mg/d and 60.7%] in 2012 group without AAPs（P〈0.05）. Conclusion The application of AAPs in chronic insomnia has been increased for 8 years, which is helpful to reduce the unreasonable application of BZDs. But there are the unreasonable application of AAPs and dependence syndrome, which should not be ignored.