北京地区30家医疗机构调剂中易混淆的3种中药饮片调查分析

Investigation and Analysis on Three Kinds of Easily Confused Traditional Chinese Medicine Decoction Pieces in 30 Medical Institutions in Beijing

目的:调查医疗机构中药饮片调剂工作,以提高中药饮片调剂质量,防止混淆,确保临床用药安全、有效。方法:选取北京市10家社区卫生服务中心、10家二级以上综合性医院和10家二级以上中医类医院,对30家医疗机构的中药房进行实地走访调查,针对调剂中易混淆的"黄柏、川黄柏""葛根、粉葛"和"金钱草、广金钱草"等3对品种,对比中药饮片药斗上的标注药名与药斗中的实际中药饮片,根据《中华人民共和国药典》判断药名是否与实物相符,不符则为调剂混淆。结果:社区卫生服务中心的调剂混淆率较高,3对易混淆品种的平均混淆率为40%(4/10);二级以上综合医院的平均调剂混淆率相对低一些,为27%(2.7/10);二级以上中医类医院的平均调剂混淆率最低,为7%(0.7/10)。结论:鉴于调剂工作中存在的品种混淆现象,应加强专业人员的技术培训,根据当地中药饮片用药习惯,制定相应的调剂规程。同时,应建立行业监察制度,加大对中药饮片的检查力度,中医药管理部门定期组织检查,从而进一步提高中药饮片调剂质量,确保临床用药安全、有效。

OBJECTIVE： To investigate the dispensing of traditional Chinese medicine（ TCM） decoction pieces in medical institutions,and to improve the quality of dispensing of TCM decoction pieces,so as to prevent confusion and ensure the safe and effective use of medicine. METHODS： 10 community health service centers,10 comprehensive hospitals of more than two level and 10 TCM hospitals of more than two level in Beijing were selected,field visit investigation was conducted in TCM pharmacies from these 30 medical institutions. According to the easily confused TCM decoction pieces like ＂cortex phellodendri vs. cortex phellodendri amurensis＂,＂puerarin vs. pueraria thomsonii benth cells＂and ＂christina loosestrife herb vs. herba desmodii styracifolii＂,the label on the medicine bucket and the actual TCM decoction pieces were compared,by reference to the Pharmacopoeia of the People＇s Republic of China,the confusion was regulated. RESULTS： The rate of confusion in community health service centers was relatively high,the average rate of confusion in three kinds of easily confused TCM decoction pieces was 40%（ 4/10）; the average rate of confusion in comprehensive hospitals of more than two level was lower,totally 27%（ 2. 7/10）; and the average rate of confusion in TCM hospitals of more than two level was the lowest,totally 7%（ 0. 7/10）. CONCLUSIONS： Due to the confusion phenomenon exists in the dispensing,it is necessary to strengthen the training on the medical staff,and formulate corespondent dispensing disciplines according to habits of drug usage of local TCM decoction pieces.Meanwhile,more importance should be attached to establish the monitoring system,strengthen the inspection on TCM decoction pieces. And the TCM management department should organize regular inspection so as to further improve the dispensing of TCM decoction pieces and ensure safe and effective medication.