| 王莉,曹乐乐,田晶晶.老年患者含冰片中成药超疗程用药风险分析与管控策略[J].安徽医药,待发表. |
| 老年患者含冰片中成药超疗程用药风险分析与管控策略 |
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| 投稿时间：2026-09-09 录用日期：2026-11-07 |
| DOI： |
| 中文关键词: 心血管内科 含冰片中成药 超疗程用药 老年人用药 合理用药 真实世界研究 |
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| 中文摘要: |
| 目的 基于真实世界临床数据,分析心血管内科含冰片中成药从“急救药长期化”的使用现状,识别老年患者用药风险,提出精细化管理策略。方法 回顾性收集某三甲医院心血管内科2024年度含冰片中成药门诊处方1 251张,参照《含冰片中成药临床合理使用与药学评价的专家共识(2022)》开展合理性评价。结合传统药性理论与现代药理学证据分析超疗程用药的成因及老年人群风险特征。结果 不合理处方占比为39.73%(497/1 251),其中超疗程用药占不合理处方的90.34%(449/497),最长连续用药达400 d(以处方频次为统计单位)。60岁及以上老年患者占全部用药人群65.87%(637/967),为主要使用群体；通心络胶囊、复方丹参滴丸、麝香保心丸是超疗程用药中出现频率最高的三种药物；4例禁忌证用药均发生于血压控制不佳的老年冠心病患者。结论 当前存在冰片“中病即止”的传统用药逻辑与现代“慢病维持”临床实践脱节的问题,老年患者因正气亏虚、多药联用更易发生相关不良反应。建议建立“辨证准入—疗程熔断—老年复评”三级管控机制,推动此类药物回归急救与短期干预定位,保障用药安全。 |
| 英文摘要: |
| Objective To investigate the phenomenon of long-term maintenance use of emergency-use borneol-containing Chinese patent medicines in the cardiovascular department, identify medication risks in elderly patients, and construct targeted management strategies. Methods A total of 1,251 outpatient prescriptions of borneol-containing Chinese patent medicines in 2024 were retrospectively collected. Rationality evaluation was performed according to the Expert Consensus on Clinical Rational Use and Pharmaceutical Evaluation of Borneol-Containing Chinese Patent Medicines (2022). The causes of over-long medication and specific risks in the elderly were analyzed combining traditional Chinese medicine property theory and modern pharmacological evidence. Results The overall irrational prescription rate was 39.73%, with inappropriate medication duration accounting for 90.34% of irrational cases, and the longest treatment course reached 400 days. Elderly patients (≥60 years old) constituted 65.87% of the study population. Tongxinluo Capsule, Compound Danshen Dropping Pills, and Shexiang Baoxin Pill were the most frequently used drugs in over-duration cases. All four cases of contraindicated medication occurred in elderly coronary heart disease patients with uncontrolled hypertension. Conclusion There is a significant disconnect between the traditional principle of "discontinuing medication once efficacy is achieved" and current long-term maintenance practice. Elderly patients are more vulnerable to adverse reactions due to qi deficiency and polypharmacy. It is recommended to establish a three-level control mechanism of "syndrome differentiation access-course interruption-geriatric re-evaluation" to promote standardized clinical application of such drugs. |
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