今日药学

2020, v.30(08) 516-520

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精神科儿童青少年门诊患者超药品说明书使用情况及其影响因素分析
Analysis of Off-label Use of Psychotropic Drugs Among Child and Adolescent Psychiatric Outpatients and Its Influencing Factors

陈曼;黄洁漩;朱秀清;
CHEN Man;HUANG Jiexuan;ZHU Xiuqing;Department of Pharmacy,The Zhuhai Center for Chronic Disease Prevention/The Third People's Hospital of Zhuhai;Department of Pharmacy,The Affiliated Brain Hospital of Guangzhou Medical University/Guangzhou Huiai Hospital;

摘要(Abstract):

目的研究精神科儿童青少年门诊患者药物超说明书用药情况及其影响因素,为促进患者临床合理用药提供更多参考依据。方法选取某院精神科门诊2017~2019年儿童青少年患者处方1 736张(医嘱条数3 178条),依据最新药品说明书对超说明书使用情况进行判断,统计患者一般临床资料及精神科药品超说明书使用情况,采用二项logistic回归分析超说明书用药的相关性因素。结果患者诊断大类以情绪情感障碍(ICD-10 F30-F39)及神经性、应激性和躯体形式障碍(ICD-10 F40-F49)为主,分别占56.8%和22.7%。处方医嘱条数最多的为丙戊酸(680条)。无儿童用药信息使用以抗精神病药(70.5%)、抗焦虑药(56.8%)为主,超适应证使用以心境稳定剂(77.6%)、镇静催眠药(39.0%)为主,而超年龄使用则以抗抑郁药(16.2%)为主。超说明书用药与患者性别(OR=1.360,95%CI=1.262~1.458)、年龄(OR=1.098,95%CI=1.069~1.127)、ICD-10 F20-F29诊断类别(OR=0.466,95%CI=0.305~0.627)、ICD-10 F40-F49诊断类别(OR=2.598,95%CI=2.467~2.729)、ICD-10 F90-F99诊断类别(OR=8.156,95%CI=7.685~8.627)、应用抗抑郁药(OR=0.175,95%CI=0.059~0.291)及心境稳定剂(OR=0.523,95%CI=0.408~0.638)有关(P<0.05)。结论本院精神科儿童及青少年门诊患者处方中普遍存在超说明书用药,药师需对其安全性及有效性进行严密监测,了解相关影响因素,并进行必要干预。
OBJECTIVE To explore the prevalence of off-label use of psychotropic drugs among child and adolescent psychiatric outpatients and its influencing factors,and to provide reference for promoting rational medication use. METHODS A total of 1 736 prescriptions(3 178 orders) of child and adolescent psychiatric outpatients of a hospital from 2017 to 2019 were selected. The off-label use was determined according to the latest package inserts. The general clinical data of patients and off-label use of psychiatric medications were counted,and the influencing factors of off-label use were analyzed by using binomial logistic regression. RESULTS Diagnosis of mood/affective disorders(ICD-10 F30-F39) and neurotic,stress-related,and somatoform disorders(ICD-10 F40-F49),which account for 56.8% and 22.7%,respectively,were major diagnostic categories of patients. Valproic acid was the most frequently prescribed drug(680 orders). Antipsychotics(70. 5%) and anxiolytics(56. 8%) were the main types of no children' s medication information use,mood stabilizers(77. 6%) and sedative hypnotics(39. 0%) were the main types of off-label indication use,while antidepressants(16.2%) were the main types of off-label age use. The patient's gender(OR = 1.360,95% CI = 1.262-1.458),age(OR= 1.098,95% CI = 1.069-1.127),diagnostic category of ICD-10 F20-F29(OR = 0.466,95% CI = 0.305-0.627),diagnostic category of ICD-10 F40-F49(OR = 2.598,95% CI = 2.467-2.729),diagnostic category of ICD-10 F90-F99(OR = 8.156,95% CI = 7.685-8.627),antidepressants(OR = 0. 175,95% CI = 0. 059-0. 291),and mood stabilizers(OR = 0. 523,95% CI = 0. 408-0. 638) were factors associated with off-label use(P < 0. 05). CONCLUSION The off-label use of psychotropic drugs are common among child and adolescent psychiatric outpatients. Pharmacists should monitor their safety and effectiveness closely,as well as the influencing factors,and conduct necessary interventions.

关键词(KeyWords): 精神科;儿童及青少年;超说明书;影响因素
psychiatric;child and adolescent;off-label use;influencing factors

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作者(Author): 陈曼;黄洁漩;朱秀清;
CHEN Man;HUANG Jiexuan;ZHU Xiuqing;Department of Pharmacy,The Zhuhai Center for Chronic Disease Prevention/The Third People's Hospital of Zhuhai;Department of Pharmacy,The Affiliated Brain Hospital of Guangzhou Medical University/Guangzhou Huiai Hospital;

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