基于临床用药与社会学视角探讨中药用药风险的原因与防控对策  

Discussion on the Causes,Prevention and Control Countermeasures of the Risks of Traditional Chinese Medicine Based on Clinical Medication and Sociological Perspectives

作　　者：祁梅[1] 顾志荣 杨浩 陈红宁 葛斌[1] QI Mei;GU Zhirong;YANG Hao;CHEN Hongning;GE Bin(Department of Pharmacy,Gansu Provincial Hospital,Lanzhou 730000,China;College of Pharmacy,Gansu University of Traditional Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省人民医院药剂科,甘肃兰州730000 [2]甘肃中医药大学药学院,甘肃兰州730000

出　　处：《西部中医药》2023年第9期55-59,共5页Western Journal of Traditional Chinese Medicine

基　　金：甘肃省中医药管理局科研项目(GZK-2019-41);甘肃省人民医院研发攻关项目(18GSSY2-3)。

摘　　要：目的:从临床用药与社会学视角探讨中药用药风险的原因与防控对策。方法:收集临床及社会上有关中药用药风险的典型案例,探讨中药用药风险原因,并提出相应防控对策。结果:中药用药风险的主要原因包括中药用药相关指南与共识建设不足,忽视中药用药警戒,临床中不严格甚至不辨证使用中药,无适应证及随意超适应证使用中药,根据偶见报道的现代药理作用随意选用中药,不合理联合使用中药,中药注射剂滴速及溶媒控制不严格,主要药味、功效主治相同或相近的中成药、汤剂、中药注射剂重复使用,以及社会舆论的非正确导向与传播等。建议进一步倡导遵守国家相关政策规定,强化中药合理使用相关政策规定与临床指南建设,构建基于临床大数据及循证医学证据的适合西医医师使用的常见疾病辨证用药数据库/手册、常见中药注射剂与中成药辨证使用数据库/手册等,建立特殊中药精准分级管理模式,加大中药安全合理使用相关科普力度与广度,积极干预医师根据偶见报道的现代药理作用随意选用中药,加强中药用药风险评价体系、预警机制及相关平台建设。结论:中药用药风险的原因涉及临床用药与社会学两个层面,应在两个层面同时加强警惕并积极合理干预。Objective:To explore the cause and the countermeasures of preventing and controlling the risk of traditional Chinese medicine based on clinical medication and sociological perspectives.Methods:Typical clinical cases and social ones about the risk of TCM were gathered to discuss the causes of the risk of TCM,and put forward the corresponding prevention and control measures.Results:The main reasons of the risk of TCM contained the lack of the guidelines and consensus on the use of TCM,neglecting herbal medication vigilance,casual herbal administration even medication without syndrome differentiation,medication without the corresponding indications or beyond the indications casually,arbitrary use of TCM based on occasionally reported modern pharmacological effects,unreasonable combination use of herbs,non-strict control of drip rate and solvent of TCM injection,repeated use of Chinese patent medicine,decoction and TCM injections with the same or similar Chinese herbs and efficacy,incorrect orientation and transmission of public opinions.Therefore,we recommend further advocating for compliance with relevant national policies and regulations,strengthening the construction of the relevant policies and regulations of rational use of herbs and clinical guidelines,building the database/manual for syndrome differentiation and medications of the common diseases based on clinical big data and evidence-based medicine suitable for physicians of Western medicine,the database/handbook for syndrome differentiation and the application of common herbal injections and Chinese patent medicine and others,establishing the precise hierarchical management mode of special TCM,increasing the strength and breadth of science popularization related to the safe and rational uses of TCM,actively intervened the doctors’random choice of TCM based on occasional reports of modern pharmacological effects,strengthening the construction of risk evaluation system of TCM,early warning mechanisms and the related platform for TCM.Conclusion:The causes f

关 键 词：中药 临床用药 用药风险 风险防控 社会舆论 

分 类 号：R288[医药卫生—中药学]