某院中药饮片超药典使用的情况调查及影响因素分析-中国药房

某院中药饮片超药典使用的情况调查及影响因素分析

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篇名：	某院中药饮片超药典使用的情况调查及影响因素分析
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摘要：	目的：调查分析某院中药饮片超药典使用情况和影响因素，探讨其理论和临床实践意义上的合理性。方法：分层随机抽取该院门诊药房2015年7－12月的中药饮片处方1 200张，对处方的一般情况、配伍禁忌情况、超限量情况和影响因素等进行回顾性、描述性分析。结果：抽取的1 200 张处方涉及378味药，共计17 826味次。其中，男性患者占45.92％，女性患者占54.08％；平均每张处方开具（14.86±5.01）味药，平均每剂药剂量为（243.73±100.84）g，平均每味药剂量为（16.41±8.57）g。含有可能产生配伍禁忌的药品共2 970 味次，涉及处方1 093 张，其中禁忌药对同方出现18 次，占处方比例的1.50％、占味次比例的0.20％。有限量标准的药品共353个品种，共计17 353味次，超限量使用率以味次计占56.64％，以品种计占94.62％，以处方计占98.83％，平均每张处方超限量使用率为（56.58±19.56）％，超限量使用率随品种数递增，各品种用量均值的偏离度为（40.19±50.37）％。不同性别、年龄的患者超限量使用率有明显差异，高年资医师更易超限量用药；超限量使用率在药物功效分类上无明显规律；限量越大，超限量情况越少见。结论：该院中药处方中禁忌配伍较少，但超限量使用现象具有严重性和普遍性，影响因素众多且复杂。中药饮片超药典使用有其理论和实践意义上的合理性，必须辨证看待，从临床实际出发，兼顾安全和疗效，促进实践和理论的同步发展与有机结合。
ABSTRACT：	OBJECTIVE： To investigate and analyze the use of TCM decoction pieces not in conformity with the Chinese Pharmacopoeia and influential factors， and to investigate its rationality on theoretically and clinically. METHODS： Stratified random sampling was adopted to select 1 200 TCM decoction pieces prescriptions from outpatient pharmacy of the hospital during Jul.-Dec. 2015 and perform a retrospective and descriptive analysis on general information， incompatibility， excess defined dose and influential factors， etc. RESULTS： 1 200 prescriptions were collected， involving 378 ingredients which appeared 17 826 times. Male occupied 45.92％ and female occupied 54.08％. （14.86±5.01） ingredients were prescribed in each prescription averagely； the amount of each dose was（243.73±100.84）g； the amount of each ingredient was（16.41±8.57）g. Incompatibility may be occurred in 2 970 ingredients， involving 1 093 prescriptions； incompatibility couplet medicines appeared in same prescription 18 times， accounting for 1.50％ of total prescriptions and 0.20％ of ingredient times. There were 353 kinds of drugs with litmit standard， involving utilization ratio of excess defined dose was 56.64％ by ingredient times， 94.62％ by types and 98.83％ by prescriptions. The proportion of excess defined dose in each prescription was （56.58±19.56）％ averagely， and utilization ratio of excess defined dose was increased as the increase of drug types； deviation degree of average amount for each type was（40.19±50.37）％. There was significant difference in utilization ratio of excess defined dose among different gender and age groups， and senior physicians were easy to use drugs over the defined dose. Utilization ratio of excess defined dose had no obvious regularity in term of efficacy classification. More large excess defined dose was， mere rare excess defined dose was. CONCLUSIONS： Incompatibility is not common in TCM prescriptions of the hospital， but excess defined dose is serious and universal； influential factors are numerous and complex. The use of TCM decoction pieces not in conformity with Chinese Pharmacopoeia is in a way acceptable in the sense of theory and practice. Practitioners are advised to view it in a dialectical way in their daily clinical practice， in order to ensure safety and effectiveness at the same time and to coordinate the practice with the theory for them to progress together.
期刊：	2017年第28卷第2期
作者：	鹿岩，刘健，郭琳琳，李妮，张红艳，田晓倩，化晓凯
AUTHORS：	LU Yan，LIU Jian，GUO Linlin，LI Ni，ZHANG Hongyan，TIAN Xiaoqian，HUA Xiaokai
关键字：	中药饮片；超药典用药；配伍禁忌；超限量用药；合理用药
KEYWORDS：	TCM decoction pieces； Drug use not in conformity with Chinese Pharmacopoeia； Incompatibility； Excess defined dose use； Rational use
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