基于某院2012~2014年度中药注射剂临床应用情况探讨中药注射剂的合理应用和监管

Investigation of Rational Use and Regulation of Traditional Chinese Medicine Injections Based on the Utility Analysis of Our Hospital from 2012 to 2014

目的结合我院中药注射剂使用情况和文献报道,探讨临床如何合理使用高风险中药注射剂。方法统计分析我院2012-2014年度门急诊和病房各科室中药注射剂的处方/医嘱使用率、处方金额占比等,结合文献检索,了解中药注射剂的使用现状并分析存在的问题。结果我院门急诊中药注射剂处方率呈逐年上升趋势,2012-2014年分别为1.19%、1.34%和1.40%;急诊、耳鼻喉和神经内科处方率和处方金额占比都稳居三甲。病房中药注射剂医嘱使用率稳定,2012-2014年分别为0.79%、0.80%和0.79%,其中肿瘤内科（20%-26%）、急诊科（12%-14%）和神经内科（10%-11%）的使用率最高,而中医科仅占4%-5%。2012-2014年中药注射剂的总金额占全院总药费金额的百分比分别为2.10%、2.07%和2.14%。我院使用强度低于文献报道。结论我院中药注射剂使用不尽合理,突出表现在非中医科室使用了绝大多数的中药注射剂。建议临床以＂中医会诊制度＂来支撑中药注射剂的合理应用,需要国家药监部门强化说明书管理,提高药品质量标准,共同呵护中药注射剂这个中药的创新产品。

OBJECTIVE To discuss the methods for clinical rational use and state regulation of high risk Traditional Chinese Medicine Injections （TCMIs） based on our hospital TCMIs analysis and literature review. METHODS By analyzing the prescription rates and amount percentage of TCMIs in emergency, outpatient and inpatient departments of our hospital as well as literature searching to learn the current state and conditions of TCMIs. RESULTS Utilities of TCMIs from 2012 to 2014 shows an elevated tendency with percentages of 1.19%, 1.34% and 1.40% respectively. Emergency, ENT and internal neurology departments of outpatient are the top 3 on prescription rates and amount percentage. Inpatients＇ order rates of TCMIs are 0. 79% , 0. 80% and 0. 79% respectively. Oncology （20% -26% ）, emergency （ 12% -14% ） and internal neurology （ 10% - 11% ） departments are the top 3 amount rates in ordering TCMIs,however, the department of TCM only account for 4% -5%. The percentages of TMCIs amount vs. annual total drug amount during 2012-2014 arc 2. 10% , 2. 07% and 2. 14% , which is lower than literature reports. CONCLUSION Not all the TCMIs use in our hospital are rational, mainly reflects in non-TCM doctors having used the most amount of TCMIs. Therefore, the TCM consultation policy should be established to support TCMI rational utility, TCMIs labels should be strictly regulated and the quality standards of TCMIs should be elevated to ensure the safety and effectiveness. All above efforts should be done to protect and develop TCMI, an innovation of TCM.