中药汤剂不良反应原因分析及合理用药探讨

Analysis on the Causes of Adverse Reactions of Traditional Chinese Medicine Decoctionand Discussion on Rational Use of Medicines

目的探究中药汤剂不良反应发生原因,以期为中药汤剂合理用药提供参考。方法回顾性分析2018年10月~2019年10月我院治疗的54例中药汤剂所致不良反应患者临床资料,分析不良反应主要表现、所累及系统结构、严重程度、涉及药物、发生时间及转归情况,归纳总结不良反应发生原因,并提出重要汤剂合理用药的对策。结果 54例患者主要表现为皮肤瘙痒、红肿、大范围斑丘疹、头晕发热、血压降低、意识不清等症状;不良反应中主要类型为全身性过敏反应,占44.44%,高于消化系统、神经系统、血液系统、呼吸系统(P<0.05);不良反应主要表现为轻度68.51%(37/54)、中度27.78%(15/54);药物不良反应涉及药物包括植物类12种,动物类5种,矿物类2种;54例不良反应患者均停药(42例)或给予对症治疗(12例),临床不良症状及体征均较治疗前明显改善和控制,治愈时间0.5~12 d,平均治愈时间(2.45±0.71)d;药物不良反应主要为药物因素,所占比例29.62%显著高于药物配伍不当、炮制方法不当、给药剂量过大、给药疗程过长、用法不当、个体差异、误服误用因素(P<0.05)。结论中药汤剂不良反应原因与多种因素相关,临床应把握好诱因,做好针对性预防,以保证中药汤剂的合理用药,进一步降低不良反应发生率,提高临床应用安全性。

Objective To explore the causes of adverse reactions of traditional Chinese medicine decoctions in order to provide references for the rational use of traditional Chinese medicine decoctions.Methods The clinical data of 54 patients with adverse reactions caused by traditional Chinese medicine decoctions treated in our hospital from October 2018 to October 2019 were retrospectively analyzed.The main manifestations of adverse reactions,the structure of the system involved,the severity,the drugs involved,the time of occurrence,and the outcome,summarize and summarize the causes of adverse reactions,and propose strategies for the rational use of important decoctions.Results 54 patients mainly showed symptoms such as skin itching,redness and swelling,extensive maculopapular rash,dizziness and fever,lowered blood pressure,and unconsciousness;the main type of adverse reactions was systemic allergic reaction,accounting for 44.44%,which was higher than the digestive system and nerves system,blood system,respiratory system(P<0.05);adverse reactions are mainly manifested as mild 68.51%(37/54)and moderate 27.78%(15/54);adverse drug reactions involve 12 kinds of plants and animals 5 kinds of minerals,2 kinds of minerals;54 patients with adverse reactions were discontinued(42 cases)or given symptomatic treatment(12 cases).The clinical adverse symptoms and signs were significantly improved and controlled compared with before treatment.The cure time was 0.5~12 d,the average cure time is(2.45±0.71)d;adverse drug reactions are mainly due to drug factors,accounting for 29.62%significantly higher than improper drug compatibility,improper preparation methods,excessive doses,long treatment courses,improper usage,individual differences,misuse and misuse factors(P<0.05).Conclusion The causes of adverse reactions of traditional Chinese medicine decoctions are related to many factors.The clinical causes should be grasped and targeted prevention should be done to ensure the rational use of traditional Chinese medicine decoctions,further reduce the incidence of adverse reactions and improve the safety of clinical application.