中成药在肺移植术后免疫抑制治疗中应用的横断面研究

A Cross-Sectional Study on the Application of Chinese Patent Medicine in Immunosuppressive Therapy After Lung Transplantation

目的:对单中心肺移植患者术后免疫抑制维持治疗中中成药的应用情况进行横断面研究,探讨中成药临床使用特点,为临床合理使用中成药提供参考。方法:收集2017年3月至2019年8月于中日友好医院就诊的肺移植患者的术后用药信息,利用SAS 9.4软件对相关数据进行分析。结果:166例肺移植患者中,术后使用中成药的共104例,占62.65%。肺移植患者术后免疫抑制维持治疗所用中成药涉及25个品种,类别包括解表剂、泻下剂、理气剂、清热剂、祛瘀剂、化痰止咳平喘剂、扶正剂和安神剂,使用病例数排序居前3位的中成药为百令胶囊、金花清感颗粒和尿毒清颗粒。104例术后使用中成药的患者中,34例(占32.69%)患者联合应用2种及2种以上的中成药。中成药不合理应用主要表现为无中医诊断、重复用药和超剂量用药。肺移植术后免疫维持治疗中,使用中成药患者与未使用中成药患者的他克莫司血药浓度比较,差异有统计学意义(P<0.0001)。结论:肺移植患者术后免疫抑制维持治疗中使用中成药应考虑方案的合理性,遵循辨证辨病相结合的原则,注重药学监护,以确保临床用药的合理性。

OBJECTIVE:To conduct a cross-sectional study on the application of Chinese patent medicine in immunosuppressive maintenance therapy on patients underwent single-center lung transplantation,to probe into the characteristics of clinical application of Chinese patent medicine,so as to provide references for rational application of Chinese patent medicine.METHODS:Postoperative medication information of patients undergoing lung transplant admitted into the China-Japan Friendship Hospital from Mar.2017 to Aug.2019,SAS 9.4 was adopted to analyze related data.RESULTS:Among the 166 patients underwent lung transplantation,104 patients had used Chinese patent medicine,accounted for 62.65%.25 categories of Chinese patent medicine were involved in postoperative immunosuppressive maintenance therapy in patients underwent lung transplantation,including diaphoretic prescription,purgative prescription,qi-regulating prescription,heat-clearing prescription,stasis-removing prescription,phlegm-resolving and cough and asthma relieving prescription,body-strengthen prescriptions and tranquillizer prescriptions,the top 3 Chinese patent medicine ranked by case load were respectively Bailing capsule,Jinhua Qinggan granule and Niaoduqing granule.Of the 104 patients used Chinese patent medicine after surgery,34 patients(32.69%)had been applied 2 or above drug combination.The irrational application of Chinese patent medicine mainly including no TCM diagnosis,repeated dose and over-dose.In the immunosuppressive maintenance therapy after lung transplantation,the difference in blood concentration of tacrolimus between patients using and not using Chinese patent medicine was statistically significant(P<0.0001).CONCLUSIONS:The rationality of therapeutic regimen of Chinese patent medicine should be considered in the immunosuppressive maintenance therapy after lung transplantation,the principle of syndrome differentiation with disease differentiation should be followed,and pharmaceutical care should be paid attention to ensure the rationality of clinical medication.