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1. 北京大学第三医院延庆医院药剂科
2. 北京中医药大学中药学院
3. 北京中医药大学中药药物警戒与合理用药研究中心
纸质出版日期:2022,
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王琚丽, 张冰, 吕锦涛, 等. 基于真实世界的基层医院心血管系统疾病中西药联合应用情况研究[J]. 中国医院用药评价与分析, 2022,22(1):83-88.
WANG Juli, ZHANG Bing, LYU Jintao, et al. Combination of Traditional Chinese and Western Medicine in the Treatment of Cardiovascular Diseases in Primary Hospitals Based on Real World[J]. 2022,22(1):83-88.
王琚丽, 张冰, 吕锦涛, 等. 基于真实世界的基层医院心血管系统疾病中西药联合应用情况研究[J]. 中国医院用药评价与分析, 2022,22(1):83-88. DOI: 10.14009/j.issn.1672-2124.2022.01.017.
WANG Juli, ZHANG Bing, LYU Jintao, et al. Combination of Traditional Chinese and Western Medicine in the Treatment of Cardiovascular Diseases in Primary Hospitals Based on Real World[J]. 2022,22(1):83-88. DOI: 10.14009/j.issn.1672-2124.2022.01.017.
目的:通过基层医院真实医疗数据
了解心血管系统疾病治疗的中西药联合应用情况
旨在为基层医院中西药合理应用提供依据。方法:选取2019—2020年北京市延庆区12家基层社区医院信息系统中90 064张门诊处方
遴选出33 234张心血管系统疾病处方以及9 649张中西药联合应用处方中心血管系统疾病患者的相关信息。对心血管系统疾病患者的一般信息、疾病情况进行描述性统计分析
采用频数分析法探讨心血管系统疾病患者的中西药联合应用情况
基于Apriori关联规则算法分析基层医院中西药联合应用的规律。结果:2019—2020年
北京市延庆区12家基层社区医院门诊心血管系统疾病处方占门诊总处方数的36.90%。33 234张门诊心血管系统处方中
中西药联合应用处方占29.03%;>45岁患者处方占96.56%(9 317张);女性患者处方(4 956张
占51.36%)多于男性患者(4 693张
占48.64%);高血压、冠心病和高胆固醇血症患者处方数合计占71.59%(6 908张)
其中高血压处方最多
共3 874张
占40.15%。中西药联合应用处方中
中药、西药品种数分别为312、223种
联合使用率较高的中西药品种包括中药外用膏剂、感冒清热颗粒、复方丹参制剂(片、滴丸)、藿香正气制剂(水、软胶囊)和牛黄清心丸等中药
阿司匹林、氨氯地平、硝苯地平和阿托伐他汀等西药;中西药联合应用类别主要涉及抗高血压药、抗血小板药和调节血脂药与理血剂、补益剂和解表剂等联合应用;关联分析结果显示
中西药联合应用置信度较高的药品中
西药相对固定
为阿司匹林、硝苯地平和氨氯地平
而中药的种类较多
包括血塞通制剂(片、软胶囊、胶囊和注射液)、脉血康胶囊、脑心通胶囊、通心络胶囊、麝香保心丸和银杏叶制剂(滴丸、片、胶囊和提取物);西药与西药联合应用方面
他汀类药物与阿司匹林的置信度较高;中药与中药联合应用方面
金匮肾气丸与五苓胶囊、血塞通制剂(片、软胶囊、胶囊和注射液)与复方丹参制剂(片、滴丸)、痹祺胶囊与大活络制剂(丸、胶囊)等的置信度较高。结论:真实世界中
基层医院呈现出心血管系统疾病患者多、中西药联合应用处方多和中西药联合应用品种多的"三多"现象
中西药多药联合应用较普遍
基层医师应注意获益与风险。
OBJECTIVE: To investigate the combination of traditional Chinese and western medicine in the treatment of cardiovascular diseases based on the real medical data in primary hospitals
so as to provide references for rational application of Chinese and western medicine in primary hospitals. METHODS: Totally 90 064 outpatient prescriptions in the hospital information system from 12 primary hospitals from 2019 to 2020 in Yanqing District
Beijing were selected
information related to patients with cardiovascular diseases in 33 234 prescriptions for cardiovascular disease and 9 649 prescriptions for combination application of Chinese and western medicine were extracted. Descriptive statistical analysis was performed on general information and disease conditions of patients with cardiovascular diseases
frequency analysis was used to explore the combined application of Chinese and western medicine in patients with cardiovascular diseases
and Apriori association rule algorithm was adopted to analyze the pattern of combined application of traditional Chinese and western medicine in primary hospitals. RESULTS: From2019 to 2020
outpatient prescriptions for cardiovascular diseases accounted for 36. 90% of the total outpatient prescriptions in 12 primary community hospitals in Yanqing District
Beijing. Among the 33 234 outpatient prescriptions for cardiovascular disease
prescriptions for combined application of traditional Chinese and western medicine accounted for 29. 03%; prescriptions for patients > 45 years accounted for 96. 56%( 9 317 prescriptions);prescriptions for female patients( 4 956 prescriptions
51. 36%) was more than male patients( 4 693 prescriptions
48. 64%); prescriptions for patients with hypertension
coronary heart disease and hypercholesterolemia accounted for71. 59%( 6 908 prescriptions)
of which the prescription for hypertension was the most
totally 3 874 prescriptions
accounting for 40. 15%. Among the prescriptions for combined application of traditional Chinese and western medicine
the number of categories of traditional Chinese and western medicine were respectively 312 and 223
the categories of traditional Chinese medicine with high use rate included traditional Chinese topical ointment
Ganmao Qingre granules
Fufang Danshen preparation( tablets and dropping pill)
Huoxiang Zhengqi preparation( oral liquid and soft capsule) and Niuhuang Qingxin pill
and that of western medicine included aspirin
amlodipine
nifedipine and atorvastatin; the categories of combined application of traditional Chinese and western medicine mainly involved combination among anti-hypertensive drugs
antiplatelet drugs
lipid-regulating drugs and blood-regulating recipe
tonic prescription and diaphoretic recipes; results of the association analysis showed that among the drugs with high confidence in the combined application of traditional Chinese and western medicine
western medicine were relatively unchanged
including aspirin
nifedipine and amlodipine
while there were more categories of traditional Chinese medicine
including Xuesaitong preparation( tablets
soft capsules
capsules and injections)
Maixuekang capsule
Naoxintong capsule
Tongxinluo capsule
Shexiang Baoxin pills and Yinxing preparation( drop pills
tablets
capsules and injections); in terms of combined application of western medicine
the confidence coefficient of statins and aspirin was higher; in terms of the combined application of traditional Chinese medicine
the confidence coefficient of Jinkui Shenqi pill and Wuling capsule
Xuesaitong preparation( tablets
soft capsules
capsules and injections) and Fufang Danshen preparation( tablets and dropping pill)
Biqi capsules and Dahuoluo preparation( pills and capsules) were higher. CONCLUSIONS: In the real world
primary hospitals have the phenomenon of more patients with cardiovascular diseases
more prescriptions for combined application of traditional Chinese and western medicine and more varieties of combined application of traditional Chinese and western medicine
the combined application of traditional Chinese and western medicine is quite common
so that primary clinicians should pay attention to the benefits and risks.
真实世界基层医院心血管系统中西药联合应用
Real worldPrimary hospitalCardiovascular systemCombined application of traditional Chinese and western medicine
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