Abstract: Background　The medication management of patients with severe mental disorders has become an important task for primary medical institutions in China. However，there is currently a lack of a systematic review on the medication management of patients and the restrictive factors for their regular medication. Objective　To systematically review the situation and influencing factors associated with medication management in Chinese patients with severe mental disorders， and to provide evidence-based evidence for optimizing patients' medication management. Methods　CNKI，WanFang，VIP and PubMed Data were searched to collect cross-sectional studies on medication management in Chinese patients with severe mental disorders and discussing the influencing factors of regular medication. The search time limit was from the establishment of the database to August 2024. Two reviewers independently screened studies，extracted data and assessed the risk of bias of included studies. Meta-analysis was conducted on the management rate，standardized management rate，medication rate， and regular medication rate in the quantitative studies using Stata 17.0 software. At the same time，a qualitative summary analysis was conducted on the influencing factors of regular medication compliance among patients with severe mental disorders. Results　A total of fifty-nine studies were included，among which 41 studies quantitatively reported four indicators of patients' medication management. The results of meta-analysis indicated that the management rate of patients with severe mental disorders in China was 91.0%（95%CI=89.0%-93.0%），the standardized management rate was 77.0%（95%CI=70.0%-83.0%），and the medication rate was 72.00%（95%CI=66.0%-79.0%）. The rate of regular medication was 50.0%（95%CI=44.0%-56.0%）. From 2014 to 2021，the management rate，standardized management rate，medication rate and regular medication rate of patients increased from 73.7%，35.8%，35.0% and 17.9% to 96.7%，94.1%，87.0% and 84.2%，respectively. The management rate remained at a similar level in the eastern（92.3%），central（94.4%） and western（92.0%） regions. The standardized management rate，medication rate and regular medication rate were all higher in the eastern（86.5%，82.5%， 62.7%），and central（81.2%，88.1%，57.9%） regions compared to the western（73.8%，64.5%，38.2%） region. Moreover，18 studies qualitatively reported the influencing factors of regular medication in patients with severe mental disorders. The summary analysis showed that the restrictive factors affecting patients' regular medication was complex and diverse，mainly coming from five aspects：patients themselves，family caregivers，community management，hospital diagnosis and treatment， and government support. Conclusion　The medication management ability of patients with severe mental disorders in China has significantly improved in recent years，but the differences among different regions are still considerable. In the future，based on multiple restrictive factors affecting patients' regular medication，collaborative management should be carried out to achieve the goal connotation of mental health management in China.

Key words: Severe mental disorders, Medication management, Regular medication, Restrictive factors, Systematic review

摘要： 背景　严重精神障碍患者服药管理已成为我国基层医疗卫生机构的重要工作，但目前尚缺乏对患者服药管理及其规律服药制约因素的系统总结。目的　系统评价中国严重精神障碍患者服药管理现状及其影响因素，为优化我国患者服药管理提供循证依据。方法　检索中国知网、万方数据知识服务平台、维普网和 PubMed 数据库，获取有关中国严重精神障碍患者服药管理情况及影响患者规律服药因素的横断面研究，检索时限均为建库至 2024 年 8 月。由 2 位研究者独立筛选文献、提取资料并评估纳入定量研究的偏倚风险后，采用 Stata 17.0 软件对定量研究的管理率、规范管理率、服药率、规律服药率进行 Meta 分析。同时对纳入严重精神障碍患者规律服药的影响因素研究进行定性汇总分析。结果　共纳入 59 篇研究，其中 41 篇研究定量报告了患者服药管理的 4 项指标。Meta 分析结果表明，我国严重精神障碍患者的管理率为 91.0%（95%CI=89.0%~93.0%），规范管理率为 77.0%（95%CI=70.0%~83.0%），服药率为 72.00%（95%CI=66.0%~79.0%），规律服药率为 50.0%（95%CI=44.0%~56.0%）。2014—2021 年，患者的管理率、规范管理率、服药率、规律服药率分别从 73.7%、35.8%、35.0%、17.9% 上升至 96.7%、94.1%、87.0%、84.2%。患者的管理率在东部（92.3%）、中部（94.4%）、西部（92.0%）地区保持相近水平，规范管理率、服药率、规律服药率均表现为东部（86.5%、82.5%、62.7%）、中部（81.2%、88.1%、57.9%）地区明显高于西部（73.8%、64.5%、38.2%）地区。此外，18 篇研究分析了严重精神障碍患者规律服药影响因素，汇总分析发现，影响患者规律服药的制约因素复杂多样，主要来自患者自身、家庭照护者、社区管理、医院诊治及政府支持五大方面。结论　我国严重精神障碍患者的服药管理能力近年来明显提升，但不同区域间的差异仍然较大。未来应基于影响患者规律服药的多方制约因素，协同管理以实现我国精神卫生管理的目标内涵。

关键词: 严重精神障碍, 服药管理, 规律服药, 制约因素, 系统评价