中成药处方点评的标准与尺度探索(二):重复用药

Exploration on the creteria and compromise of prescription review of Chinese patent medicinesⅡ:repeated medication

中成药处方点评是推动医院合理应用中药的重要环节,也是中药临床药学的重要内容。其中,重复用药是经常遇到的问题之一,但目前其判别依据较为多样,评价标准尚未统一。针对此问题,本文梳理中成药处方分析中的重复用药点评现状,论述其中的四大关注点,包括判断适应证是否重复、组方药味是否重复、是否属于同一功效类别、是否含有特殊组分(毒、烈性饮片和化学药物),并细化探讨各依据的不同细则和优缺点。在此基础上,提出重复用药判别条件的组合化趋势,尝试设计了包含7项指标(适应证、药味数目、功效类别、特殊组分、药品数目、给药途径、患者病情)的重复用药评分量表和相应阈值。最后,探讨了中药相须相使的配伍文化对重复用药的潜在影响,寻找并分析真实世界的重复用药案例。综合以上内容,探索中成药重复用药的标准与尺度,为合理用药提供方法学参考。

The prescription comment of Chinese patent medicine is the important part of clinical pharmacy in Traditional Chinese Medicine（TCM）,which promotes the hospital rational drug use.The repeated medication,which always appears in the results of prescription comment,however,has not come from the normative evaluation standards.According to the current literatures about prescription analysis,this paper tired to elucidate the four key points which included the judgment of indications,ingredients,efficiency classes and special components between the Chinese patent medicines used together.We also analyzed the details and advantages of each key point.Then we proposed the combination trend of judged criteria,and designed a kind of Repeated Medication Scale（RMS）for comprehensive assessment.The RMS contained 7 indexes such as indications,ingredients,efficiency classes,special components,number of used drugs,administration routes and patient status.At last,the influence of TCM compatibility on repeated medication and real-world cases were demonstrated.Above all,the standard and allowance of repeated medication in prescription comment were explored for promoting rational drug use.