刘军刚　李喜香　刘效栓　张民　肖正国

摘要：目的 分析中西藥联合应用处方合理性，探讨中西药联合应用评价中的问题。方法 随机抽取甘肃省中医院（以下简称“本院”）每月门诊中西药联合应用处方共12期，依照相关法规制定中西药联合应用评价制度进行点评并统计汇总。结果 本研究共抽取1900张中西药联合应用处方，抽样处方占医院同期全部处方（含饮片处方）的8.67%，占同期单纯西药处方加单纯中成药处方总和的20.87%，符合处方点评抽样率的要求；骨科处方占绝大多数，每张骨科处方平均用药品种数和用药金额低于总体平均值。样本中包括1852例患者，男796例，女1056例；中年患者（36～60岁）联合用药最多，占总患者人数49.46%；涉及诊断3990条，中医诊断1908条，西医诊断2082条，骨科病类诊断占50%以上；未辨证用药、用法用量不适宜、未注意药物相互作用是中西药联合应用的主要问题。结论 本院中西药联合应用处方占比小，处方结构与科室规模、患者年龄、疾病诊断相适应，今后要加强对处方辨证施药、用法用量及药物相互作用的评价与干预。

关键词：中西医结合；中西药联用；处方评价

DOI：10.3969/j.issn.1005-5304.2018.04.027

中图分类号：R288 文献标识码：A 文章编号：1005-5304（2018）04-0122-03

Abstract： Objective To analyze the rationality of the combined application prescriptions of traditional Chinese and Western medicine； To discuss the problems in the evaluation of the combined application of traditional Chinese and Western Medicine. Methods A total of 12 issue monthly outpatient combination application prescriptions of traditional Chinese and Western medicine were randomly selected in Gansu Provincial Hospital of Traditional Chinese Medicine （Here in after referred to as “this hospital”）. According to the relevant laws and regulations， evaluation rules of the combined application traditional Chinese and Western medicine was developed， reviewed and statistically summarized. Results Totally 1900 prescriptions were sampled in the study and accounted for 8.67% in all prescriptions （including prescription of traditional Chinese herbal medicine） and accounted for 20.87% of all prescription of pure Western medicine and pure traditional Chinese patent medicine in the same period， which meet the requirements of sampling rate. Prescriptions of department of orthopedics accounted for the majority. The average number of drugs and the average amount of each prescription of department of orthopedics were lower than the overall average. The sample consisted of 1852 patients， 796 males and 1056 females. Middle-aged patients （36-60 years old） of combined medication were up to 49.46% of the total number of patients. 3990 terms of diagnosis were involved， including 1908 terms of traditional Chinese medicine diagnosis and 2082 terms of Western medicine diagnosis. Orthopedics disease diagnosis accounted for more than 50%. The main problems of the combined application of traditional Chinese and Western medicine were the non syndrome differeentiationg use of medicine， inappropriate usage and dosage， and the lack of attention to medicine interactions. Conclusion The combined application prescriptions of traditional Chinese and Western medicine of this hospital account for a small proportion. Prescription structure adapts with the size of the department， patient age and disease diagnosis. In the future， the prescription evaluation and intervention of syndrome differeentiationg application and dosage and medicine interaction should be strengthened.

Keywords： integrated traditional Chinese and Western medicine； combined application of traditional Chinese and Western medicine； prescription evaluation

中西药联合应用合理与否直接关系到临床疗效和患者用药安全。2013-2015年国家药品不良反应年度报告显示，在所有发生不良反应的报告中，存在中西药联用情况占40%以上，且严重报告中涉及中西药联用情况占50%以上[1-3]。因此，加强中西药联合应用处方/医嘱的评价和干预，对促进临床合理用药、保障用药安全有着十分重要的意义。……