2021—2022年某三级甲等中西医结合医院中成药临床应用问题分析

Clinical Application of Chinese Patent Medicines in a GradeⅢ,Level A Integrated Traditional Chinese and Western Medicine Hospital from 2021 to 2022

目的:结合某三级甲等中西医结合医院(以下简称“该院”)中成药使用情况及专项医嘱点评,探讨中成药临床应用的合理性。方法:采用回顾性研究,统计2021—2022年该院病区中成药的使用品种、使用金额、使用强度、用药频度(DDDs)、药品使用金额排序(B)/DDDs排序(A)以及中成药相关药品不良反应(ADR)报告情况。抽取2021—2022年使用中成药的住院医嘱4800份,进行专项医嘱点评,汇总分析中成药在临床应在中存在的不合理用药问题。结果:该院病区中成药的使用中,中药注射剂的应用较广泛;连续2年使用金额排序均居前5位的药品有肾康注射液、鸦胆子油乳注射液、醒脑静注射液;肾康注射液、鸦胆子油乳注射液的使用强度排序均居前3位;B/A>1.5的药品有宁泌泰胶囊、宽胸气雾剂、培元通脑胶囊,肾康注射液连续2年B/A<0.5,其余大部分中成药的B/A在0.5~1.5。4800份使用中成药的住院医嘱中,存在不合理用药问题的医嘱共465份(占9.69%),不合理用药问题涉及药物以祛湿剂、祛瘀剂及开窍剂多见,主要表现为适应证不适宜、重复用药、联合用药不适宜、用法与用量及疗程不适宜。中成药相关ADR报告中,口服剂型占比最高,其次为注射剂。结论:该院病区中成药的临床应用基本合理,需重点关注中药注射剂的使用及ADR情况,通过持续开展医嘱点评相关工作、加强用药监管,进一步促进临床合理用药、减少药品不良反应。

OBJECTIVE:To probe into the clinical application rationality of Chinese patent medicines based on the application of Chinese patent medicine and the review of special medical orders in a gradeⅢ,level A integrated traditional Chinese and Western Medicine hospital(hereinafter referred to as“the hospital”).METHODS:Retrospective study was conducted to analyze the categories,consumption sum,use intensity,defined daily dose system(DDDs),drug consumption sum ranking(B)/DDDs ranking(A)and adverse drug reactions(ADR)related to Chinese patent medicines in the ward of the hospital from 2021 to 2022.Totally 4800 inpatient medical orders with Chinese patent medicines from 2021 to 2022 were selected for special medical order review,and irrational drug use problems existing in clinical application of Chinese patent medicines were summarized and analyzed.RESULTS:Traditional Chinese medicine injections were widely used in the inpatient department of this hospital.The top 5 drugs ranked by consumption sum in 2 consecutive years included Shenkang injection,brucea jananica oil injection,and Xingnaojing injection.Shenkang injection and brucea jananica oil injection ranked the top 3 in terms of use intensity.The drugs with B/A>1.5 were Ningmitai capsules,Kuanxiong aerosol inhalation and Peiyuan Tongnao capsules,Shenkang injection with B/A<0.5 for 2 consecutive years,while the B/A of most Chinese patent medicines was from 0.5 to 1.5.Among the 4800 inpatient medical orders with Chinese patent medicines,there were 465 cases(9.69%)with irrational drug use.The irrational drug use problems were mainly related to drugs of dampness removing,drugs of blood stasis removing and resuscitation,which were mainly manifested as inappropriate indications,repeated drug use,improper drug combination,and inappropriate usage,dosage and course of treatment.In the ADR reports related to Chinese patent medicines,oral dosage forms accounted for the highest proportion,followed by injections.CONCLUSIONS:The clinical application of Chinese patent medicine in the hospital is basically reasonable,and it is necessary to focus on the use of traditional Chinese medicine injections and ADR,and further promote clinical rational drug use and reduce adverse drug reactions by carrying out the relevant work of medical order review and strengthening medication supervision.