世界中医药

作者	单位
管涛1，董永强2	1 北京医院药学部，国家老年医学中心，北京，100730； 2 首都医科大学附属北京中医医院药学部，北京，100010

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中文摘要:

目的：观察分析中药饮片处方的规范性与用药可合理性，以提高临床中药饮片的规范、合理使性用。方法：选取2015年12月至2016年11月在我院各科室开出的中药饮片处方1 980张（165张/月），选择我院的资深中医药师数名，成立复核小组，对所有处方进行研究分析，统计处方的不规范、不合理情况，包括诊断、使用、书写的不规范，药物数量、剂量的不合理性等。结果：纳入的1 980例处方中，合格1 620例，规范率81.82%；不合格360例，不规范率18.18%。诊断、书写、用法的不规范率分别为6.72%、48.13%、5.86%；书写不规范的处方中主要以脚注和字迹不规范问题最为严重，发生率分别为22.22%、20.25%。详细数据见表2。纳入的1 980例处方中，处方合理为1 315例，合理率66.41%，不合理675例，不合理率34.09%。处方中饮片数量、单味药材剂量不合理率分别为26.67%、28.48%。处方中大毒、有毒、小毒药材的使用率分别为0.00%、4.04%、20.56，共487例（24.60%）；其中有4.95%的有毒和小毒药材使用过量，有毒和小毒药材剂量合理率95.06%。详细数据见表3。结论：我院中药材饮片处方的规范率良好，毒性饮片用药合理性较佳，但常规药材用药合理性欠缺，饮片数量、剂量偏大，且存在一定的书写不规范问题，需要加强对以上问题的关注和妥善处理。

English Summary:

To observe and analyze the normalization of Chinese herbal medicine pieces prescription and rationality of medication, so as to improve the standardization and rationality of the use of Chinese herbs.Methods:A total of 1,980 prescriptions (165 per month) from all departments in Beijing Hospital from December 2015 to November 2016 were selected.A number of senior Chinese medicine pharmacists were selected to establish a review group to analyze all prescriptions.Prescriptions that lack of normalization and reasonableness were collected, including improper diagnosis, use, writing, number and dosage.Results:A total of 1 620 cases were qualified among the included 1980 prescriptions with 81.82% normalization rate.And there were 360 unqualified cases, accounting for 18.18% non-normalization rate.The non-normalization rates of diagnosis, writing, usage were respectively 6.72%, 48.13% and 5.86%.In the prescriptions lack of normalization, the main problems were footnote and handwriting, with occurrence rate of 22.22% and 20.25% respectively (see Table 2).Among the included 1,980 prescriptions, 1 315 cases were reasonable, accounting for 66.41%, and 675 cases were unreasonable, accounting for 34.09%.The unreasonable rate of number and dosage in prescripts were 26.67% and 28.48% respectively.The use rates of herbs with great toxin, toxin and little toxin were 0.00%, 4.04%, 20.56%, with a total of 487 cases (24.06%).Among them, 4.95% of herbs with great toxin and little toxin were over used, and the rational rate of herbs with toxin and little toxin was 95.06% (see Table 3).Conclusion:The normalization rate of Chinese herbal medicine prescriptions in our hospital was good with excellent reasonability rate of usage of toxin herbs, but the use of conventional herbs lacks reasonability with larger number and dosage, and also existed certain problems in handwriting, which needs attention and to be properly dealt with.

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