湖南省新型农村合作医疗基本药品目录(修订版).docx

湖南省新型农村合作医疗基本药品目录（修订版）一、西药部分1抗微生物药1.1抗生素类抗感染药1.1.1青霉素类编号用药级别药品名称剂型限制使用范围010101011阿莫西林(羟氨苄青霉素)片剂、胶囊剂、颗粒剂、注射剂、干糖浆010101021氨苄西林钠(氨苄青霉素)注射剂、胶囊剂、颗粒剂010101031苯唑西林钠(苯唑青霉素)注射剂010101041氯唑西林钠(邻氯青霉素)注射剂010101051青霉素钠盐，钾盐注射剂010101061阿莫西林钠/克拉维酸钾或舒巴坦钠片剂、干糖浆、注射剂、混悬剂注射剂限价10元/0.5克以下010101071氨苄西林钠/舒巴坦钠片剂、注射剂注射剂限价10元/0.5克以下010101081哌拉西林钠注射剂010101091氨苄西林氯唑西林注射剂 010101101苄星青霉素注射剂010101112美洛西林注射剂限二线用药010101122阿洛西林注射剂限二线用药010101132羧苄西林注射剂限二线用药010101142盐酸仑氨西林片剂1.1.2头孢菌素010101151头孢氨苄片剂、胶囊剂、颗粒剂010101161头孢羟氨苄片剂、胶囊剂、颗粒剂010101171头孢拉定片剂、胶囊剂、注射剂注射剂限价10元/0.5克以下010101181头孢噻肟钠注射剂限价10元/0.5克以下010101191头孢唑林钠注射剂010101201头孢呋辛钠片剂、注射剂注射剂限价10元/0.5克以下010101211头孢克洛片剂、胶囊剂、颗粒剂010101221头孢哌酮钠注射剂限二线用药 限价10元/0.5克以下010101232头孢哌酮钠/舒巴坦钠联合制剂注射剂限二线用药 限价10元/0.5克以下010101242头孢他啶注射剂限二线用药 限价10元/0.5克以下010101252头孢替唑钠注射剂限二线用药 限价10元/0.5克以下010101262头孢曲松钠(头孢三嗪)注射剂限二线用药 限价10元/0.5克以下010101273头孢丙烯分散片、混悬剂010101283拉氧头孢注射剂010101293头孢吡肟注射剂限重症患者1.1.3碳青霉烯类010101302亚胺培南/西司他丁钠注射剂限重度烧伤感染010101313美罗培南注射剂010101322氨曲南注射剂1.1.4氨基糖甙类010101331硫酸阿米卡星 (丁胺卡那霉素)注射剂、滴眼液010101341硫酸庆大霉素注射剂、片剂、胶囊剂010101351奈替米星注射剂限肾功能有损害者010101362依替米星注射剂010101371妥布霉素注射剂010101381新霉素片剂010101391小诺霉素片剂、注射剂010101401卡那霉素注射剂1.1.5酰胺醇类010101411氯霉素片剂、注射剂1.1.6四环素类010101421四环素 片剂010101431盐酸多西环素 (脱氧土霉素，强力霉素)片剂、胶囊剂010101441盐酸土霉素片剂010101452盐酸米诺环素片剂、 胶囊剂、颗粒剂010101461金霉素眼膏1.1.7大环类脂类010101471红霉素片剂、注射剂、眼膏剂、软膏剂010101481琥乙红霉素颗粒剂、片剂、胶囊剂010101491阿奇霉素胶囊剂、片剂、颗粒剂、混悬剂、粉针剂注射剂限安瓿剂 限二级用药010101501罗红霉素片剂、胶囊剂、颗粒剂010101511乙酰螺旋霉素片剂、胶囊剂010101521吉他霉素片剂010101531克拉霉素片剂010101541麦迪霉素片剂010101552交沙霉素片剂1.1.8其他类010101561盐酸林可霉素注射剂、片剂、胶囊剂、滴耳剂010101572盐酸克林霉素(氯洁霉素)胶囊剂、注射剂010101581磷霉素钠注射剂、胶囊剂010101592万古霉素注射剂限金葡菌引起的重度感染010101602去甲万古霉素注射剂限金葡菌引起的重度感染010101612多粘菌素B注射剂限二线用药010101623替考拉宁注射剂限二线用药1.2合成抗菌药1.2.1磺胺类010102011复方磺胺甲噁唑片剂010102021磺胺嘧啶片剂、注射剂010102031磺胺嘧啶银粉剂、软膏剂010102041硫氮磺吡啶片剂、栓剂010102051甲氧苄啶片剂010102061联磺甲氧苄啶片剂1.2.2硝基呋喃类010102071呋喃妥因肠溶片剂010102081呋喃唑酮片剂1.2.3喹诺酮类010102091诺氟沙星(氟哌酸)胶囊剂010102101氧氟沙星(氟嗪酸)片剂、胶囊剂、滴耳剂、滴眼液、注射剂010102111盐酸环丙沙星片剂、胶囊剂、滴眼液、滴耳液、注射剂010102121盐酸洛美沙星片剂、胶囊剂、注射剂注射剂限二线用药010102131左氧氟沙星片剂、胶囊剂、注射剂、滴眼液注射剂限二线用药010102142莫西沙星胶囊、片剂限二线用药1.2.4硝咪唑类010102151甲硝唑片剂、胶囊剂、注射剂、阴道泡腾片剂010102161替硝唑胶囊、片剂、注射剂、葡萄糖注射液010102173奥硝唑片剂、胶囊、注射剂注射剂限二线用药1.3其他 类1.3.1抗感染植物类010103011乌洛托品片剂010103021大蒜素胶囊、注射剂010103031盐酸小檗碱(黄连素)片剂1.4抗分枝杆菌类药010104011对氨基水杨酸钠片剂、注射剂010104021利福平胶囊剂、片剂、混悬剂、注射剂010104031硫酸链霉素注射剂010104041盐酸乙胺丁醇片剂、胶囊剂010104051异烟肼(雷米封)片剂、注射剂010104061吡嗪酰胺片剂、胶囊剂010104071利福喷汀片剂、胶囊剂010104081异烟肼/利福平片剂010104092异烟肼/利福平胶囊剂（组合药）010104101异烟肼/利福平/吡嗪酰胺片剂010104112异烟肼/利福平/吡嗪酰胺胶囊剂（组合药）010104122卷曲霉素注射剂010104131丙硫异酰胺片剂010104142异烟肼/利福平/吡嗪酰胺/乙胺丁醇片剂（组合药）010104152对氨基水杨酸异烟肼片剂010104162氨苯砜片剂010104173沙利度胺片剂1.5抗真菌药010105011制霉素片剂、栓剂010105021氟康唑片剂、注射剂注射剂限系统真菌感染010105031克霉唑片剂、胶囊剂、霜剂、软膏、乳膏剂010105041硝酸咪康唑片剂、软膏、栓剂010105051特比萘芬霜剂、软膏010105061酮康唑片剂、胶囊剂、霜剂、软膏010105072伊曲康唑片剂、注射剂限系统真菌感染010105081灰黄霉素片剂010105091两性霉素B片剂、注射剂010105102益康唑软膏剂010105111特比萘芬片剂1.6抗病毒药010106011阿昔洛韦片剂、注射剂、滴眼液、软膏剂010106021利巴韦林(三氮唑核苷)片剂、胶囊剂、注射剂、滴眼液、颗粒010106031碘苷片剂010106041金刚烷胺片剂010106051吗啉胍片剂010106062阿糖腺苷注射剂010106073膦甲酸钠注射剂010106082拉米夫定片剂2抗寄生虫病药2.1抗吸虫病药010201011吡喹酮片剂010201021硫氯酚片剂、胶囊剂010201031硝硫氰胺片剂、胶囊剂010201041酒石酸锑钾注射剂2.2抗疟药010202011硫酸奎宁片剂、注射剂010202021磷酸伯氨喹片剂010202031双氢青蒿素片剂010202041磷酸氯喹注射剂、片剂010202051乙胺嘧啶片剂、膜剂010202061青蒿素栓剂010202071磷酸哌喹片剂010202081咯奈啶片剂2.3驱肠虫药010203011甲苯咪唑片剂010203021盐酸左旋咪唑片剂、糖浆剂010203031阿苯达唑片剂、胶囊剂010203041哌嗪片剂、糖浆剂010203051恩波维铵片剂2.4抗丝虫病及抗黑热病药010204011喷他脒片剂010204021枸橼酸乙胺嗪片剂2.5抗阿米巴病药及抗滴虫病药010205011甲硝唑片剂010205021甲硝唑注射剂010205031双碘喹啉片剂010205041盐酸依米丁注射剂3解热镇痛及非甾体抗炎镇痛药3.1解热镇痛及非甾体抗炎镇痛药010301011阿司匹林片剂、肠溶片剂、栓剂010301021布洛芬片剂、胶囊剂010301031安乃近片剂、滴鼻剂010301041安痛定注射剂010301052吡罗昔康片剂、胶囊剂010301061布洛芬缓释胶囊剂、乳膏010301071对乙酰氨基酚片剂、胶囊剂、颗粒剂010301081复方阿司匹林片剂010301091复方对乙酰氨基酚片剂、胶囊剂、薄膜衣片剂010301102复方氨酚烷氨胶囊010301111复方氨基比林注射剂010301121双氯芬酸钠盐，钾盐片剂、缓释片剂、缓释胶囊剂、乳胶剂010301131吲哚美辛肠溶片剂、胶囊、乳膏剂010301141氯芬那酸片剂010301151贝诺酯片剂010301161右旋酮洛芬肠溶片剂010301172美洛昔康片剂010301182尼美舒利片剂、颗粒剂3.2抗痛风药010302011别嘌醇片剂010302021丙磺舒片剂010302031秋水仙碱片剂010302041苯溴马隆片剂4麻醉用药4.1全身麻醉药010401011恩氟烷液体剂010401021异氟烷液体剂010401031硫喷妥钠注射剂010401041盐酸氯胺酮注射剂010401051丙泊酚（异丙酚）注射剂限国产药品010401061麻醉乙醚吸入剂010401073羟丁酸钠注射剂4.2局部麻醉药010402011盐酸利多卡因注射剂010402023盐酸布比卡因注射剂010402031盐酸丁卡因注射剂010402041盐酸普鲁卡因注射剂010402051盐酸利多卡因喷雾剂010402061盐酸利多卡因胶浆剂4.3镇痛药010403011芬太尼注射剂010403023芬太尼贴剂010403031盐酸吗啡片剂、注射剂限主治医师以上使用010403041吗啡盐酸盐，硫酸盐缓(控)释片剂限主治医师以上使用010403051盐酸哌替啶注射剂010403061罗痛定（左旋四氢帕马丁）注射剂、片剂010403071麦角咖啡因片剂010403081盐酸曲马多胶囊剂、滴剂、缓释片剂、注射剂、栓剂010403092舒芬太尼注射剂010403101盐酸布桂嗪注射剂、片剂010403111去痛片片剂010403121安络痛片剂010403131麦角胺咖啡因片剂4.4麻醉辅助药010404011氯化琥珀胆碱注射剂010404022盐酸乙哌立松片剂010404032维库溴铵注射剂限国产药品010404041氟哌利多注射剂 010404051麻黄碱片剂、注射剂010404061筒箭毒碱注射剂010404071盐酸纳络酮注射剂5维生素及矿物质缺乏症用药010500011葡萄糖酸钙片剂、注射剂注射剂限安瓿剂010500021维生素B1片剂、注射剂注射剂限安瓿剂010500031维生素B12片剂、注射剂注射剂限安瓿剂010500041维生素B6片剂、注射剂注射剂限安瓿剂010500051维生素C片剂、注射剂注射剂限安瓿剂010500061维生素B2片剂、注射剂注射剂限安瓿剂010500071干酵母片剂010500081氯化钙注射剂010500091维生素A胶囊剂010500101维生素D3片剂、胶囊剂010500112维生素D3注射剂010500121烟酸片剂010500131氯化钙注射剂010500141碳酸钙片剂、胶囊 010500151维生素E胶丸010500162帕米膦酸二钠注射剂010500172复合维生素B片剂6营养治疗药010600012脂肪乳中链及长链复合剂注射剂限重症病人伴肠功能障碍010600021复方氨基酸18,18F,18AA,18AA-1, 18AA-5注射剂限二线用药010600031复方氨基酸3AA注射剂限二线用药010600041复方肝病用氨基酸注射剂限二线用药010600051复方肾病用氨基酸注射剂限肾病用药、二线用药7激素及调节内分泌功能药7.1下丘脑垂体激素及其类似物010701012促皮质素注射剂010701021去氨加压素注射剂010701031绒促性素注射剂010701041垂体后叶素注射剂010701052戈舍瑞林片剂限二线用药010701063尿促性素注射剂010701073氯米芬片剂010701083重组人生长激素注射剂7.2肾上腺皮质激素类药010702011醋酸地塞米松片剂、软膏剂、注射剂、软膏010702021泼尼松片剂010702031氢化可的松片剂、软膏剂、注射剂010702042倍他米松片剂、注射剂010702051泼尼松龙片剂、注射剂、眼膏010702062曲安奈德软膏剂、注射剂010702072甲泼尼松龙注射剂限国产药品010702082甲泼尼龙片剂限国产药品010702092甲泼尼龙琥珀酸钠注射剂、片剂限国产药品7.3雄激素及同化激素类药010703011苯丙酸诺龙注射剂010703021丙酸睾酮注射剂010703031甲睾酮片剂010703042达那唑胶囊剂限国产药品010703052替勃龙胶囊 7.4雌激素及孕激素类药010704011己烯雌酚片剂、注射剂010704021苯甲酸雌二醇注射剂、凝胶剂010704032尼尔雌醇片剂010704042醋酸甲羟孕酮片剂、胶囊剂、注射剂010704051黄体酮注射剂010704062炔诺酮片剂、滴丸010704072醋酸甲地孕酮胶囊剂010704082戊酸雌二醇片剂7.5胰腺素及其他影响血糖药010705011胰岛素指普通胰岛素注射剂010705021精蛋白锌胰岛素注射剂010705031低精蛋白锌胰岛素注射剂010705041格列本脲片剂010705051盐酸二甲双胍片剂010705061格列吡嗪片剂、胶囊剂、缓释剂、控释片010705071格列齐特片剂、胶囊剂010705081格列喹酮片剂010705091格列美脲片剂010705102阿卡波糖片剂、胶囊剂010705112瑞格列奈注射剂、片剂7.6甲状腺激素及抗甲状腺药010706011甲状腺片片剂010706021左旋甲状腺素片剂010706032复方碘溶液(卢戈氏液)口服液010706041丙硫氧嘧啶片剂010706051甲巯咪唑(他巴唑)片剂8调节免疫功能药010800011雷公藤多苷片剂010800021硫唑嘌呤片剂010800033胸腺肽注射剂限40元/日量010800042环孢素片剂、胶囊剂限国产药品、限器官移植用010800052吗替麦考酚脂片剂、胶囊剂限国产药品、限器官移植用和SLE010800062重组人白介素-2注射剂限肿瘤病人010800072细辛脑注射液注射剂010800082薄芝糖肽注射液注射剂9抗肿瘤药9.1烷化剂抗肿瘤药010901012环磷酰胺片剂、注射剂010901022塞替派注射剂限国产药品010901032司莫司汀胶囊剂限国产药品010901042盐酸氮芥注射剂010901052白消安（马利兰）片剂010901063异环磷酰胺注射剂010901072苯丁酸氮芥片剂010901082美司钠注射剂010901092硝卡芥注射剂010901103洛莫司汀胶囊剂010901112尼莫司汀注射剂010901123卡莫司汀注射剂9.2抗代谢类抗肿瘤药010902012阿糖胞苷注射剂010902022氟尿嘧啶片剂、胶囊剂、注射剂010902032甲氨蝶呤片剂、注射剂010902042羟基脲片剂、胶囊剂010902053羟基脲注射剂010902062替加氟片剂、注射剂010902073卡莫氟胶囊剂、注射剂、片剂010902083氟达拉滨注射剂 010902093吉西他滨注射剂010902103卡培他滨片剂010902112巯嘌呤片剂9.3抗生素类抗肿瘤药010903012放线菌素D(更生霉素)注射剂010903022丝裂霉素注射剂010903032盐酸阿霉素(多柔比星)注射剂010903042盐酸平阳霉素注射剂010903052盐酸柔红霉素注射剂限肿瘤科和血液科使用010903062盐酸表阿霉素(表柔比星)注射剂010903072盐酸吡柔比星（吡喃阿霉素）注射剂9.4天然来源抗肿瘤药010904012高三尖杉酯碱注射剂010904022硫酸长春新碱(醛基长春碱)注射剂010904032羟喜树碱注射剂010904042依托泊苷注射剂010904052依托泊苷胶囊剂限肿瘤科和血液科使用010904063盐酸拓扑替康冻干粉针剂限三级以上医院肿瘤科使用010904072长春地辛注射剂010904082紫杉醇注射剂限国产药品010904092替尼泊苷注射液限国产药品9.5激素类抗肿瘤药010905012氨鲁米特片剂010905022枸橼酸他莫昔芬片剂010905032来曲唑片剂010905041比卡鲁胺片剂9.6其他010906012卡铂注射剂010906022盐酸丙卡巴肼(甲基巴肼)片剂、胶囊剂010906032顺铂注射剂010906042盐酸米托蒽醌注射剂限肿瘤科和血液科使用010906053维A酸胶丸010906062达卡巴嗪（氮烯咪胺）注射剂010906072门冬酰胺酶注射剂9.7抗肿瘤辅助药010907012昂丹司琼(恩丹西酮)片剂、注射剂限用于肿瘤病化疗病人010907023亚叶酸钙注射剂限三级以上肿瘤医院使用010907032盐酸格拉司琼注射剂、胶囊剂限用于肿瘤病化疗病人10抗变态反应药011000011马来酸氯苯那敏(扑尔敏)片剂、注射剂011000021盐酸苯海拉明片剂、注射剂011000031盐酸异丙嗪(非那根)注射剂011000041阿司咪唑片剂011000051茶苯海明片剂011000061氯雷他定片剂011000071盐酸西替利嗪片剂011000081酮替芬片剂011000091赛庚啶片剂011000102咪唑斯汀片剂011000111硫酸羟氯喹片剂011000123粉尘螨滴剂11神经系统用药11.1抗震颤麻痹药011101011盐酸苯海索片剂、胶囊剂011101021左旋多巴片剂、胶囊剂011101032多巴丝肼片剂、胶囊剂011101042金刚烷胺片剂、胶囊剂11.2抗重症肌无力药011102011甲硫酸新斯的明注射剂011102021溴吡斯的明片剂011102032氢溴酸加兰他敏片剂、注射剂11.3抗癫痫药011103011苯妥英钠片剂、注射剂011103021丙戊酸钠片剂、注射剂、糖浆剂011103031卡马西平片剂、胶囊剂011103041氯硝西洋片剂011103051丙戊酸镁片剂、 注射剂11.4脑血管病用药011104011尼莫地平片剂、注射剂011104022巴曲酶(降纤酶)注射剂011104031氟桂利嗪片剂、011104042长春西汀注射剂限急性缺血性脑血管病011104051盐酸丁咯地尔注射剂、片剂011104062阿魏酸钠 注射剂011104073倍他司汀注射剂011104082烟酸肌醇酯片剂011104093尼麦角林片剂011104102长春胺缓释胶囊11.5中枢兴奋药011105011盐酸洛贝林(山梗菜碱)注射剂011105021尼可刹米注射剂011105031吡拉西坦(吡乙酰胺)片剂、胶囊剂、注射剂011105041盐酸二甲弗林片剂、注射剂011105051胞二磷胆碱注射剂注射剂限安瓿剂011105063盐酸甲氯芬酯注射剂011105072多沙普仑注射剂011105082哌甲酯片剂011105092奥拉西坦胶囊剂011105103马来酸桂哌齐特注射剂11.6镇静催眠药011106011苯巴比妥片剂、注射剂011106022司可巴比妥钠片剂、胶囊剂、注射剂011106032咪达唑仑片剂、注射剂011106042佐匹克隆片剂、胶囊剂011106052阿普唑仑片剂011106062碳酸锂片剂011106072晕痛定胶囊剂11.7其他011107011甘露醇注射剂011107021细胞色素C注射剂011107031甘油果糖注射剂12治疗精神障碍用药12.1抗精神病药011201011奋乃静片剂、注射剂011201021氟哌啶醇片剂、注射剂011201031舒必利片剂、胶囊剂、注射剂011201041盐酸氯丙嗪片剂、注射剂011201051盐酸三氟拉嗪片剂011201061氯普噻吨片剂、注射剂011201071氯氮平片剂011201081氟哌啶醇葵酸酯注射剂011201092盐酸帕罗西汀片剂011201102氟哌噻吨片剂、注射剂限国产药品011201112氟哌利多注射剂限国产药品011201122盐酸硫必利注射剂限国产药品011201132硫利达嗪片剂限国产药品011201142五氟利多片剂、口服缓释剂限国产药品011201152癸氟奋乃静注射剂、片剂、口服缓释剂限国产药品011201162米氮平片剂限国产药品011201172富马酸喹硫平片剂、口服缓释制剂限国产药品011201182阿立哌唑片剂限国产药品12.2抗焦虑药011202011地西泮(安定)片剂、注射剂、膜剂011202021艾司唑仑(舒乐安定)片剂011202031多塞平片剂011202042硝西泮片剂12.3抗躁狂抗抑郁药011203011碳酸锂片剂011203021盐酸阿米替林片剂011203031盐酸丙米嗪(米帕明)片剂011203041盐酸氯米帕明注射剂011203051谷维素片剂011203061盐酸氟西汀片剂、胶囊剂限国产药品011203072曲唑酮片剂限国产药品011203082西酞普兰片剂限国产药品011203092氯米帕明片剂限国产药品011203102噻奈普汀片剂限国产药品011203112马普替林片剂、口服液体剂限国产药品011203122文拉法辛片剂、胶囊剂13呼吸系统用药13.1祛痰药011301011氯化铵片剂011301021盐酸溴己新片剂011301031溴环己胺醇片剂、注射剂011301042溴环己胺醇口服溶液剂011301051乙酰半胱氨酸片剂、喷雾剂011301062糜蛋白酶注射剂011301072羧甲司坦片剂13.2镇咳药011302011复方甘草片剂、合剂011302021枸橼酸喷托维林片剂、糖浆剂011302031复方美沙芬片剂、胶囊剂、糖浆剂011302042磷酸苯丙哌林片剂、胶囊剂、口服液、冲剂011302051可待因片剂、口服液13.3平喘药011303011氨茶碱片剂、缓释片剂、注射剂注射剂限安瓿剂011303021茶碱片剂、缓释片剂、缓释胶囊剂011303031二羟丙茶碱片剂、注射剂011303041硫酸沙丁胺醇片剂、气雾剂、注射剂011303052硫酸特布他林片剂、气雾剂、喷粉剂011303062盐酸克仑特罗片剂、膜剂、气雾剂、栓剂011303072盐酸班布特罗片剂011303082去氯羟嗪片剂011303093布地奈德雾化混悬液011303103丙酸氟替卡松气雾剂011303113昔萘酸沙美特罗气雾剂011303123多索茶碱胶囊剂011303133盐酸丙卡特罗片剂、胶囊剂14消化系统用药14.1抗酸药及抗溃疡病药011401011复方氢氧化铝凝胶剂011401021盐酸雷尼替丁片剂、注射剂、胶囊剂011401031奥美拉唑胶囊剂、片剂、注射剂注射剂限二级以上医院、主治医师以上使用011401041法莫替丁片剂、胶囊剂、注射剂011401051枸橼酸铋钾(胶体次枸橼酸铋)片剂、胶囊剂、颗粒剂011401061胶体果胶铋胶囊剂011401072盐酸哌仑西平片剂011401081硫糖铝片剂、胶囊剂、混悬剂011401091西咪替丁(甲氰咪胍)片剂、胶囊剂、注射剂011401102泮托拉唑注射剂限主治医师以上使用011401113泮托拉唑胶囊剂011401121铝碳酸镁片剂011401133尼扎替丁片剂