目的 探讨应用鹿瓜多肽注射液治疗的颈椎病患者的临床特征与联合用药规律.方法 选取2004年2月—2014年11月23家三级甲等医院的医院信息系统(HIS)中使用鹿瓜多肽注射液治疗的2901例颈椎病患者的临床信息.对患者的临床特征进行描述性统计分析,采用频数分析法、关联分析探讨颈椎病患者使用鹿瓜多肽注射液的联合用药情况.结果 2901例颈椎病患者中45~64岁者1726例(59.5%);发病率排在前3位的合并症分别为腰椎间盘突出症(9.6%,278/2901)、骨折(8.7%,251/2901)、高血压(6.0%,174/2901).253例患者记录了中医证型,排在前3位的证型分别为气滞血瘀证136例(53.8%)、肝肾亏虚证83例(32.8%)、痰瘀证8例(3.2%).2901例患者均记录了鹿瓜多肽注射液联合中、西药使用情况,使用率排在前3位的西药分别为甲钴胺(41.4%,1201/2901)、腺苷钴胺(38.1%,1104/2901)、甘露醇(22.1%,642/2901),排在前3位的中药分别为颈舒颗粒(22.1%, 642/2901)、金天格胶囊(18.4%,533/2901)、强骨胶囊(10.0%,289/2901);使用率排在前3位的西药药理作用类别分别为抗生素(50.6%,1468/2901)、营养神经药(45.8%,1328/2901)、高渗脱水药(44.8%,1299/2901),排在前3位的中药类别分别为活血化瘀剂(59.2%,1716/2901)、补肾壮骨剂(33.3%,967/ 2901)、清热解毒剂(13.7%, 397/2901).关联规则分析结果显示,在鹿瓜多肽注射液+2类西药/中药的组合方式中,支持度排在首位的为鹿瓜多肽注射液+肾上腺素注射液+多巴胺、鹿瓜多肽注射液+生脉注射液+参附注射液;在鹿瓜多肽注射液+2类别西药/中药的组合方式中,支持度排在首位的为鹿瓜多肽注射液+抗酸及抗溃疡药+抗休克药、鹿瓜多肽注射液+清热解毒剂+活血化瘀剂.结论 真实世界中应将45~64岁人群作为颈椎病的重点关注人群,临床上鹿瓜多肽注射液联合中、西药使用的治疗模式最为常用;其中与活血化瘀类、补肾壮骨类中药,抗生素类、营养神经类西药联合最为常用.%Objective To investigate the clinical features and rules for using Lugua polypeptide injection in combination with other drugs among patients with cervical spondylosis. Methods From the hospital information system (HIS) of 23 tertiary grade A hospitals, we collected the in-hospital data of totaled 2 901 cervical spondylosis cases who were treated by Lugua polypeptide injection from February 2004 to November 2014. Descriptive statistical analysis of the clinical characteristics was performed. Frequency analysis and association analysis were carried out to explore the use of Lugua polypeptide injection in combination with other drugs. Results Of the 2 901 cases, 1 726 (59.5%) were 45-64 years old; top 3 complications were lumbar intervertebral disc herniation (9.6%,278/2 901), fracture (8.7%,251/2 901), and hypertension (6.0%,174/2 901); the 3 leading syndromes among 253 cases whose TCM syndromes were recorded were qi stagnation and blood stasis syndrome [136 cases (53.8%)], asthenia of liver and kidney [83 cases (32.8%)], phlegm-stasis syndrome [8 cases (3.2%)]. All of them were treated by combination use of Lugua polypeptide injection and other drugs (western/Chinese drugs). The most frequently used 3 western drugs were methylcobalamin [41.4% (1 201/2 901)], cobamamide [38.1% (1 104/2 901)] and mannitol [22.1% (642/2 901)] ,respectively;the top 3 used Chinese medicines were Jingshu granules [22.1% (642/2 901)], Jintiange capsule [18.4% (533/2 901)], Qianggu capsule [10.0% (289/2 901)], respectively; in terms of pharmacological action, the most frequently used 3 categories of western drugs were antibiotics [50.6% (1 468/2 901)], nerve nutrition drugs [45.8% (1 328/2 901)], hypertonic dehydrating agents [44.8% (1 299/2 901)], respectively; the most commonly used 3 categories of Chinese medicine were agents for promoting blood circulation to remove blood stasis [59.2%(1 716/2 901)], agents for tonifying the kidney and strengthening the bone [33.3%(967/2 901)], and those for clearing away heat and toxic materials [13.7% (397/2 901)]. Association rule analysis revealed that, of the combination of Lugua polypeptide injection + 2 types of western/Chinese medicine, Lugua polypeptide injection + Epinephrine injection +dopamine and Lugua polypeptide injection + Shengmai injection + Shenfu injection won the greatest support; the greatest support were Lugua polypeptide injection + antacid and antiulcer drug + antishock drug, and Lugua polypeptide injection + agents for clearing away heat and toxic materials + agents for promoting blood circulation to remove blood stasis. Conclusion In the management of cervical spondylosis, as the high-risk population, people aged 45-64 years should be paid special attention. For clinical treatment of this disease, Lugua polypeptide injection combined with Chinese and western medicine is most commonly used. The commonest Chinese medicines involved in the therapy are agents for promoting blood circulation to remove blood stasis, and tonifying the kidney and strengthening the bone, and the commonest western medicines are antibiotics and nerve nutrition agents.
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