社区医院中成药不适宜联用目录清单的建立及用药调研

Survey of list of Chinese patent medicine unsuitable for combination use in community hospitals

目的 构建基于我院药品目录的中成药不适宜联用品种目录清单,选取最常见不适宜联用组合,随访既往用药患者,为基层医疗机构的处方用药和审核点评提供依据。方法 首先,根据中医药基本理论和专家共识,形成了以“重复用药”“寒热冲突”和“配伍禁忌”为主的“三位一体”的联合用药评价体系,并基于我院用药品种形成不适宜联用目录。经医院伦理委员会通过后,于2021年、2022年分两次开展中成药重复用药的电子处方筛选,选择高频次组合进行处方收集和患者随访,修订完善中成药不适宜联用目录。结果 我院目前共有中成药125种(含2种中西药复方制剂和1种按西药管理的中药提取物制剂),根据专家共识,共识别出重复用药组合51组、寒热冲突组合102组、解表与滋补的不当联用组合260组、十八反十九畏配伍禁忌组合20组,共计428组(重复计减5组)。在电子病历系统中收集2020年10月—12月的处方9276张和2022年1月—6月的处方18 179张,寻找到出现频次大于5例的中成药重复用药组合4种,分别为强力枇杷露+复方甘草片(16例)、维C银翘片+连花清瘟胶囊(14例)、加味逍遥丸+八珍益母丸(20例)、人参归脾丸+加味逍遥丸(13例)。联系患者进行随访,共发出问卷42份,共回收问卷22份,其中15份选择“安全有效”,2份选择“有效但有轻微副作用”,5份选择“效果不佳”。结论 建立了我院中成药不适宜联用目录,提高医师处方用药的合理性。

Objective To establish a list of unsuitable combinations of Chinese patent medicines based on the drug catalogue of our hospital,to provide reference for prescription review and rational drug use.Methods Firstly,according to the basic theory of Traditional Chinese Medicine (TCM) and consensus reports,a combination drug use evaluation system based on “repeated drug use”,“cold and heat conflict” and “compatibility” was established.An unsuitable combination drug use catalogue was constructed based on the drug varieties in our hospital.The unsuitable combinations with the highest frequency were selected retrospectively from the electronic medical record system of hospital patient medication from October to December 2020.A follow-up investigation was conducted on patients through the family medical team,whose results we revised and used to improve the catalogue of unsuitable combinations.Results Totally 125 Chinese patent medicines in our hospital were confirmed (including 2 compound preparations of Chinese and Western medicine and 1 Chinese medicine extract preparation).According to the consensus report,a total of 428 unsuitable combination groups were identified,including 51 repeated drug use combinations,102 cold and heat conflict combinations,260 improper combinations of relieving cold symptoms and nourishing,and 20 incompatible and counteractive combinations.In the electronic case system,9276 prescriptions from October to December 2020 and 18 179 prescriptions from January to June 2022 were collected.Four repeated combinations of Chinese patent medicines in more than 5 patients were found:Qiangli Pipa Lu + Fufang Gancao tablets (16 patients),Wei C Yinqiao Tablets + Lianhua Qingwen capsules (14 patients),Jiawei Xiaoyao pills + Bazhen Yimu pills (20 patients),and Renshen Guipi pills + Jiawei Xiaoyao pills (13 patients).Patients were contacted for follow-up.Totally 42 questionnaires were delivered and 22 questionnaires were answered:15 chose “safe and effective”,2“effective but with slight side effects”,and 5“poor effect”.Conclusion The catalogue of Chinese patent medicines unsuitable for combination use in our hospital is established.The rationality of doctors’ prescriptions is improved,and the drug publicity and education are highly praised by doctors and patients.