世界中医药

目的:分析中药注射剂不合理用药情况，并总结其不良反应的防治措施。方法：选取2017年1月至2018年12月海南医学院第一附属医院的中药注射剂处方5 013张作为研究对象，按照中药注射剂说明书统计分析其不合理用药发生情况，记录不合理用药后患者不良反应发生情况，统计发生不良反应的处方所涉及患者一般资料，探索影响中药注射剂相关不良反应发生的因素，并总结合理用药对策与不良反应防治措施。结果：本研究中存在不合理用药的中药注射剂处方295张（5.88%）；不合理用药情况中占比前3位的为超适应证用药（34.24%）、超剂量、超浓度或过快滴注（28.81%）、超疗程用药或无医嘱下长期用药（17.97%）；中药注射剂不合理用药患者发生药物不良反应51例（17.29%），最为多发的不良反应类型为皮肤系统及其附件损害、消化系统损害、神经系统损害；Logistic回归分析显示，<10岁、合并用药是导致使用中药注射剂后患者发生不良反应的危险因素（OR=34.106，P=0.000；OR=4.952，P=0.004）。结论：中药注射剂不合理用药现状较为普遍，临床应加大管理力度，促使临床依据中医辨证的理论严格掌握药物的用法用量和使用范围，保证中药注射剂的治疗效果和安全性。

English Summary:

To analyze the irrational drug use of traditional Chinese medicine injection and summarize the prevention treatment measures of adverse reactions.Methods:A total of 5013 prescriptions of traditional Chinese medicine injections in First Affiliated Hospital of Hainan Medical College from January 2017 to December 2018 were selected as research objects.The occurrence of irrational drug use was analyzed according to the instructions of traditional Chinese medicine injections.The occurrence of adverse reactions in patients after unreasonable drug use was recorded.The general data of patients involved in the occurrence of adverse reactions were counted.The factors affecting the occurrence of adverse reactions related to traditional Chinese medicine injections were explored.Reasonable drug use measures and adverse reaction prevention and control measures were summarized.Results:There are 295(5.88%)prescriptions of traditional Chinese medicine injections with unreasonable use in this study; The first 3 unreasonably used drugs were over-indication medication(34.24%),over-dose,over-concentration or too-fast drip(28.81%),over-course medication or long-term medication without doctor's advice(17.97%); There were 51 cases(17.29%)of adverse drug reactions in the patients with irrational drug use in the traditional Chinese medicine injection,and the adverse reaction types account for the skin system and its accessory damage,the digestive system damage and the damage of the nerve system; Logistic regression analysis showed that less than 10 years old and combination of drugs were risk factors for adverse reactions of patients after using traditional Chinese medicine injection(OR=34.106,P=0.000; OR=4.952,P=0.004).Conclusion:The present situation of irrational drug use of traditional Chinese medicine injection is relatively common.Clinical management should be strengthened to make clinical use and scope of drugs strictly regulated according to the theory of traditional Chinese medicine,so as to ensure the therapeutic effect and safety of traditional Chinese medicine injection.

查看全文查看/发表评论下载PDF阅读器