精神科治疗药物浓度监测中实验室警戒值分析  

Analysis of laboratory alert values in therapeutic drug monitoring for psychiatry

作　　者：李萍[1] 张少川[1] 槐艳[1] 黄秋燕 雷颖佳 邱敏 LI Ping;ZHANG Shaochuan;HUAI Yan;HUANG Qiuyan;LEI Yingjia;QIU Min(Department of Laboratory,Mental Hospital of Yunnan Provincial,Kunming 650000,China)

机构地区：[1]云南省精神病医院检验科,昆明市650000

出　　处：《临床合理用药杂志》2024年第23期5-10,16,共7页Chinese Journal of Clinical Rational Drug Use

基　　金：云南省精神病医院院内立项(SJKY-2023-14)。

摘　　要：目的分析医院精神科药物浓度超警戒值情况,为保证患者的安全、有效用药提供参考。方法通过LIS信息检索系统收集2021年1月—2023年11月云南省精神病医院接受血药浓度监测的所有门诊及住院患者性别、年龄及治疗药物监测(TDM)原始数据、监测次数等。纳入该时间段服用精神科药物期间血药浓度监测结果超过警戒值的803例次TDM结果作为研究数据,超实验室警戒浓度的TDM原因分析则通过查询电子病例系统和LIS系统获得患者基本信息和服用药物情况。采用Excel软件汇总门诊和住院患者性别、年龄和血药浓度数据。采用SPSS 26.0统计学软件对患者TDM结果、合并用药情况等进行统计和分析。结果2021年1月—2023年11月总共完成检测83838例次,涉及精神科药物28种,其中门诊患者27141例次,住院患者56697例次。检测例数最多的为喹硫平(11902例次),其他依次为奥氮平(7185例次)、丙戊酸(6397例次)、氯氮平(5552例次)、阿立哌唑(3997例次)、碳酸锂(3986例次)、舍曲林(3597例次)等。监测结果超过实验室警戒值803例次(0.96%),其中男236例次,女567例次,相较于男性,女性患者出现实验室警戒浓度的概率显著更高(1.14%vs.0.69%,P<0.05);出现实验室警戒浓度的平均年龄为(30.58±20.14)岁,不同年龄段患者发生实验室警戒浓度的概率不同,但无显著差异(P>0.05);超过实验室警戒浓度的住院患者中与联合用药相比,单用1种精神科药物治疗的患者出现实验室警戒浓度的概率更低,占4.93%。结论警戒浓度的出现与性别和联合用药有关,因此,适当增加女性和联合用药患者血药浓度监测次数有利于提高用药安全性。在临床实践中,建议出现TDM异常值时,实验室检测人员应加强与临床医师沟通,积极寻找异常原因,同时临床药师结合患者病历分析原因给予临床医师合理用药建议,提高临床医师合理监测意识,从而保证患者Objective To analyze the occurrence of therapeutic drug concentration monitoring exceeding laboratory alert values in the psychiatric department of hospitals,providing a reference to ensure patient safety and effective medication use.Methods Through the LIS information retrieval system,data were collected on the gender,age,and original therapeutic drug monitoring(TDM)data,as well as the number of monitoring instances,for all outpatient and inpatient patients who underwent blood drug concentration monitoring at the Mental Hospital of Yunnan Provincial from January 2021 to November 2023.A total of 803 instances of TDM results,where the blood drug concentration monitoring results exceeded the alert values during the administration of psychiatric medications within this time frame,were included as research data.The reasons for TDM exceeding the laboratory alert concentrations were obtained through the electronic medical record system and the LIS system by querying the basic information of the patients and their medication usage.Excel software was used to summarize the gender,age,and blood drug concentration data of outpatient and inpatient patients.Additionally,SPSS 26.0 statistical software was utilized to perform statistics and analysis on the patients′TDM results and concurrent medication situations.Results From January 2021 to November 2023,a total of 83838 tests were completed,involving 28 types of psychiatric medications.Of these,27141 tests were conducted on outpatients and 56697 tests on inpatients.The most frequently tested medication was quetiapine,with 11902 tests.This was followed by olanzapine(7185 tests),valproate(6397 tests),clozapine(5552 tests),aripiprazole(3997 tests),lithium carbonate(3986 tests),and sertraline(3597 tests),among others.In the monitoring results,803 tests(0.96%)exceeded the laboratory alert threshold,including 236 tests in males and 567 tests in females.Compared to males,female patients had a significantly higher probability of exceeding the laboratory alert concentration(1.14%vs.

关 键 词：精神科药物 治疗药物浓度监测 警戒值 精神科 合理用药 

分 类 号：R969.1[医药卫生—药理学]