对某住院患者使用抗精神病药物致不良反应报告的分析

目的：分析某院住院患者使用抗精神病药致药物不良反应（adverse drug reaction，ADR）的特点，旨在提高患者用药的安全性。方法：回顾性分析该院2013-2018年上报的374例抗精神病药物致ADR的报告，依据患者基本信息、用药情况、药品品种、ADR的发生剂量及临床表现进行统计分析。结果：（1）271例（72.46%）患者单独使用一种抗精神病药物，其中8例（2.14%）使用第1代抗精神病药，263例（70.32%）使用第2代抗精神病药；103例（27.54%）患者联合使用2种抗精神病药，其中7例（1.87%）联用第1代与第2代药物，96例（25.67%）联用第2代与第2代药物。（2）ADR构成比前五位的药品依次是利培酮、奥氮平、氯氮平、阿立哌唑及齐拉西酮。（3）将引发ADR的药物剂量换算成氟哌啶醇理论等价剂量，联合用药组日平均剂量为13.42±5.10 mg，单一用药组日平均剂量为6.84±3.57 mg，2组剂量差异有显著性（P<0.05）。（4）ADR临床症状主要有肌张力障碍、心慌、震颤、静坐不能及便秘；联合用药组肌张力障碍、震颤、静坐不能、流涎及泌乳ADR构成比高于单一用药组，差异有显著性（P<0.05）。结论：我院抗精神病药物治疗以单一用药为主导，联合用药发生ADR的风险更高。使用抗精神病药物治疗中应权衡利弊，谨慎增加剂量、更换药物和联合用药，并加强ADR的监测，以确保患者用药的安全性。

Analysis of adverse drug reactions caused by antipsychotic drugs in the inpatients in our hospital

OBJECTIVE To analyze the characteristics of adverse drug reaction (ADR) induced by antipsychotics in order to improve the safety of antipsychotic drugs.METHODS A total of 374 case reports from 2013 to 2018 were analyzed retrospectively according to general information of patients, ratio of antipsychotic polypharmacy, dosage and types of antipsychotic drugs and clinical manifestations of ADRs.RESULTS (1) 271 (72.46%) patients were treated with one antipsychotic alone, of which 8 (2.14%) patients were treated with first generation antipsychotics and 263 (70.32%) patients were treated with second generation antipsychotics; 103 (27.54%) patients were treated with two antipsychotics in combination, of which 7 (1.87%) patients were treated with combined first and second generation drugs and 96 (25.67%) patients were treated with combined second and second generation drugs. (2) The top five ADR components were risperidone, olanzapine, clozapine, aripiprazole and ziprasidone.(3) The dose of drug causing ADR was converted into the theoretical equivalent dose of haloperidol.The average daily dose of combination group was 13.42±5.10 mg, and the average daily dose of single drug group was 6.84±3.57 mg. There was significant difference between the two groups (P<0.05).(4) The main clinical symptoms of ADR were dystonia, palpitation, tremor, akathisia and constipation. Moreover, the incidences of dystonia, tremor, akathisia, drooling and lactation in combined group were much higher than those in monotherapy group(P<0.05).CONCLUSION Antipsychotic monotherapy was still recommended as the first line therapy in our hospital. However, combined antipsychotics were frequently and commonly used for patients with schizophrenia and their risks were relatively higher. Therefore, in routine clinical practice, it is recommended that psychiatrists should carefully balance the benefits and risks before making treatment decisions. After the start of the combination drug use, patients' response to treatment and ADR monitoring should be regularly carried out to promote the medication compliance of patients and safe use of drugs.