跳到主要內容

臺灣博碩士論文加值系統

(3.236.84.188) 您好!臺灣時間:2021/08/04 23:22
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:吳佳欣
研究生(外文):Chia-Hsin Wu
論文名稱:因藥物濫用相關疾病至某醫學中心急診就醫病患的特質
論文名稱(外文):Characteristics of Patients Who Visited the Emergency Department of a Medical Center due to Drug Abuse Related Illnesses
指導教授:楊振昌楊振昌引用關係
指導教授(外文):Chen-Chang Yang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:環境與職業衛生研究所
學門:工程學門
學類:環境工程學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:90
中文關鍵詞:急性中毒個案對照研究藥物濫用急診
外文關鍵詞:acute poisoningcase-control studydrug abusemergency department
相關次數:
  • 被引用被引用:1
  • 點閱點閱:267
  • 評分評分:
  • 下載下載:32
  • 收藏至我的研究室書目清單書目收藏:1
摘要
目的:
近年來物質濫用在國內日益盛行,藥物濫用相關的疾病或中毒個案也逐漸增加,但相關危害的程度尚欠缺瞭解。本研究欲探討因藥物濫用相關疾病至某醫學中心急診就醫病患的特質。
材料與方法:
本研究收集並分析2007年1月至2008年12月因藥物濫用相關疾病至台北榮民總醫院急診就醫,且經臨床毒物實驗室檢驗為藥物濫用陽性的病患資料,另以1:1的個案對照研究方式,分析藥物濫用者與非藥物濫用者在基本特質、臨床資料、醫療利用及預後上之差異。
結果:
研究期間共收集到294名藥物濫用相關疾病且檢驗呈陽性之個案,使用的藥物以安眠鎮靜類藥物佔大多數(81.0%)。病患至急診就醫的主要原因為自殺(82.3%),有超過六成的病患需要住院治療。個案的死亡率為1%。
在複邏輯式迴歸分析中,相較於非藥物濫用者,因藥物濫用相關疾病至急診就醫的病患多為女性、高中畢業、有吸菸與飲酒的習慣、多經由救護車送醫、較少有併存疾病的情形(Charlson Comorbidity Index< 3)、且經適當治療後往往有較好的預後。
結論:
本研究結果發現,相較於非藥物濫用者,藥物濫用者的檢傷分類多半屬第一級,且多經由救護車送醫,顯示藥物濫用相關疾病的嚴重性,須立即性治療,且要耗用較多的醫療資源。為預防濫用藥物相關之危害,必須加強國内濫用藥物的管理政策,並提昇相關疾病之診斷與治療水準。

關鍵字:急性中毒、個案對照研究、藥物濫用、急診
Abstract
Objectives:
The prevalence of drug abuse in Taiwan has been increasing in recent years. The number of drug abuse related illnesses and poisonings is also increasing; however little is known about the magnitude of such hazards. The aim of this study was to understand the characteristics of patients who visited the emergency department (ED) of a medical center due to drug abuse related illnesses.

Materials and Methods:
We collected and analyzed the data of patients who visited the ED of Taipei Veterans General Hospital because of drug abuse related illnesses and who were tested positive for abused drugs by the clinical toxicology laboratory between January 2007 and December 2008. We also conducted a 1:1 case-control study to explore the differences in baseline characteristics, clinical data, utilization of medical care, and outcomes between patients with and patients without drug abuse.

Results:
During the study period, a total of 294 patients who had drug abuse related illnesses and were tested positive for abused drugs were identified. Most of the patients (81.0%) abused benzodiazepines or other sedative-hypnotics. The main reason of ED visit was attempted suicide (82.3%); more than 60% of the patients required hospitalization. The case fatality rate was 1%.
In multiple logistic regression analysis, case patients (drug abusers) were more likely to be females, senior high school graduates, smokers and ethanol drinkers; visited ED by ambulance more frequently; had fewer comorbidities (Charlson Comorbidity Index < 3); and had better prognosis after appropriate treatment, as compared to the control patients (non-abusers).

Conclusions:
As compared to non-drug abusers, we found that drug abusers were more likely to be classified as triage level one and visited ED by ambulance more frequently, which indicated the higher severity of drug abuse related illnesses and their need of prompt therapy and more utilization of medical resources. To prevent drug abuse related hazards, a better policy to control drug abuse in Taiwan is warranted; the diagnosis and treatment of drug abuse related illnesses also need improvement.

Key words: acute poisoning, case-control study, drug abuse, emergency department
目錄
摘要 I
Abstract III
目錄 V
表目錄 VII
第一章 前言 1
第一節 研究背景與動機 1
第二節 研究目的 4
第二章 文獻回顧 5
第一節 國內外藥物濫用現況與危害 5
第二節 急診病患與藥物濫用之相關研究 12
第三節 醫療利用及臨床相關研究 19
第三章 材料與方法 23
第一節 研究設計 23
第二節 研究對象與方法 24
第三節 變項定義 27
第四節 資料統計與分析 32
第四章 結果 33
第一節 藥物濫用者的現況及社會人口學資料 33
第二節 藥物濫用中毒者的臨床特質與醫療利用 35
第三節 單變項分析 37
第四節 複邏輯斯迴歸分析 39
第五章討論 45
第一節 因藥物濫用相關疾病至急診就醫病患之特質探討 45
第六章 結論 55
參考文獻 56















表目錄
表1、2007-2008年因藥物濫用相關疾病至台北榮總急診就醫病患的藥物濫用種類分布 (N= 294) 63
表2-1、2007-2008年因藥物濫用相關疾病至台北榮總急診就醫病患的社會人口學特質與健康行為 (N= 294) 64
表2-2. 2007-2008年因藥物濫用相關疾病至台北榮總急診就醫病患的社會人口學特質與健康行為 (N= 294)(續) 65
表3-1. 2007-2008年因藥物濫用相關疾病至台北榮總急診就醫病患的臨床特質與醫療利用概況 (N= 294) 66
表3-2. 2007-2008年因藥物濫用相關疾病至急診就醫病患的臨床特質與醫療利用概況 (N= 294)(續) 67
表4. 2007-2008年因藥物濫用相關疾病至台北榮總急診就醫病患的住院日數、醫療費用與生化檢驗值 (N= 294) 68
表5-1. 藥物濫用個案及對照組在行為與社會人口學特質及健康行為之單變項分析 69
表5-2. 藥物濫用個案及對照組在行為與社會人口學特質及健康行為之單變項分析(續) 70
表6. 藥物濫用個案及對照組在行為與臨床特質及醫療利用之單變項分析 71
表7. 藥物濫用個案及對照組在行住院日數之分佈 72
表8. 藥物濫用個案及對照組在各項特質之複邏輯斯回歸 73
表9-1. 藥物濫用者與各預測因子間之相關性-以男性之分析 74
表9-2. 藥物濫用者與各預測因子間之相關性-以女性之分析 75
表10-1. 藥物濫用者與各預測因子間之相關性-以青壯年為對象之分析 76
表10-2. 藥物濫用者與各預測因子間之相關性-以較年老者為對象之分析 77
表11. 藥物濫用者與各預測因子間之相關性-以就診原因為自殺者之分析 78
表12. 藥物濫用者與各預測因子間之相關性-以使用安眠鎮靜類藥物者之分析 79
表13. 藥物濫用者與各預測因子間之相關性 80
參考文獻
1、 行政院衛生署第15卷14期,1999。
2、 行政院衛生署新聞稿:衛生署調查發現濫用藥物情況嚴重,2007。
3、 管制藥品管理局新聞稿:新興濫用藥物潛藏多重危機~無毒人生精采萬分,2008。
4、 行政院衛生署管制藥品管理局。藥物濫用:藥物濫用之防制、危害、戒治,2002。
5、 行政院衛生署藥物濫用案件暨檢驗統計資料。行政院衛生署,2007。
6、 行政院衛生署新聞搞:94年全國藥物濫用調查結果出爐,藥物濫用者,多因「好奇、趕流行」,且亦受同儕影響。行政院衛生署管制藥品管理局,2006。
7、 楊振昌:變色的人生–談認識毒品及如何戒毒。臺北,黎明出版社,2005。
8、 吳秀貞,Combating the International Drug Problem: Trends and Developments ,2007。
9、 陳國東、張國頌、唐麗慧:台北某教學醫院急診病人藥物濫用流行病學研究,1999。
10、 江振亨。認知行為團體療法對濫用藥物者輔導成效之研究。嘉義:國立中正大學犯罪防治研究所碩士論文,1999。
11、 Addington J, Duchak V. Reasons for substance use in schizophrenia. ActaScand. 1997;96:329-333.
12、 Hall AP, Henry JA. Illicit drugs and surgery. Int J Surg. 2007;5:365-370.
13、 Ball J, Jorper S, Woodward A. Reporting drug abuse in the emergency department. JAMA. 2000;284:564.
14、 Brookoff D, Campbell EA, Shaw LM. The underreporting of cocaine-related trauma: Drug Abuse Warning Network vs hospital toxicology tests. Am J Public Health. 2003;83:369-371.
15、 Binks S, Hoskins R, Salmon D, Benger J. Prevalence and healthcare burden of illegal drug use among emergency department patients. Emerg Med J. 2005;22:872-873.
16、 Bronstein AC, Spyker DA, Cantilena Jr LR, Green J, Rumack BH, Heard SE. 2006 Annual report of the American Association of Poison Control Centers’ National Poison Data System. Clin Toxicol. 2007;45:815-917.
17、 Curran GF, Sullivan G, Williams K, et al. Emergency department use of persons with comorbid psychiatric and substance abuse disorders. Ann Emerg Med. 2003;41:659-667.
18、 Cherpitel CJ, Borges G. Screening for drug use disorders in the emergency department: performance of the rapid drug problem screen (RDPS). Drug Alcohol Depend. 2004;74:171-175.
19、 Chen WJ, Fang CC, Shyu RS, Lin KC. Underreporting of illict drug use by patients at emergency departments as revealed by two-tiered urinalysis. Addictive Behaviors. 2006;31:2304-2308.
20、 Dunn, M., Degenhardt L, Stafford J. NSW trends in ecstasy and related drug markets 2005: Findings from the party drugs initiative (PDI). Sydney: National Drug and Alcohol Research Centre, University of New South Wales,2006.
21、 French MT, McGeary KA, Chitwood DD, McCoy CB. Chronic illicit drug use, health service utilization and the cost of medical care. Soc Sci Med. 2000;1703-1713.
22、 Grant B. DSM-IV, DSM-III-R, and ICD-10 alcohol and drug abuse/harmful use and dependence, United States, 1992: a nosological comparison. Alcohol Clin Exp Res. 1996;20:1481-1488.
23、 Gray SD, Fatovich DM, McCoubrie DL, Daly F. Amphetamine-related presentations to an inner-city tertiary emergency department: a prospective evaluation. Med J Aust. 2007;186:336-339.
24、 Givens ML, Wald R, Schafer J, Wian Jr F, Delaney K. Prevalence of cocaine use in ED patients with severe hypertension. Am J Emerg Med. 2007;25:612-615.
25、 Hansen GR. The drug-seeking patient in the emergency room. Emerg Med Clin Am. 2005;23:349-365.
26、 Huber FX, Hacker T, Meeder PJ. Problems and costs associated with alcohol and drug abuse in emergency medicine. Eur J Health Econ. 2006;7:196-198.
27、 Hulse GK, Robertson SI, Tait RJ. Adolescent emergency department presentations with alcohol- or other drug-related problems in Perth, Western Australia. Addiction. 2001;96:1059-1067.
28、 Ineke K, Marianne GF, Ariel E, Gilles B. Smoking in psychiatric inpatients: Association with working status, diagnosis,comorbid substance abuse and history of suicide attempts. Addict Behav. 2009;6:1-6.
29、 Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and abuse of opioid analgesics. JAMA. 2000;283:1710-1714.
30、 Degenhardt L, Dunn M. The epidemiology of GHB and ketamine use in an Australian household survey. International Journal of Drug Policy 19. 2008; 311-316.
31、 Lex BW. Alcohol and other drug abuse among women. Alcohol Health and Reach World. 1994;18:212-219.
32、 McCarron MM, Schulze BW, Thompson GA, Condor MC, Goetz WA. Acute phencyclidine intoxication: incidence of clinical findings in 1,000 cases. Ann Emerg Med. 1981;10:237-242.
33、 Moritz E, Goulle JP, Girault C, Clarot E, Droy JM, Muller JM. Toxicological analysis in agitated patients. Intensive Care Med. 1999;25:852-854.
34、 McGeary KA, French MT. Illict drug use and emergency room utilization. Health Serv Res. 2000;35:153-169.
35、 Uzun O, Cansever A, Basoglu C, Ozsahin A. Smoking and substance abuse in outpatients with schizophrenia: a 2-year follow-up study in Turkey. Drug Alcohol Depend. 2003;70:187-192.
36、 Rich JA, Singer DE. Cocaine-related symptoms in patients presenting to an urban emergency department. Ann Emerg Med. 1991;20:616-621.
37、 Razzino BE, Ribordy SC, Grant K, Ferrari JR, Bowden BS, Zeisz J. Gender-related processes and drug use: Self-expression with parent, peer group selection, and achievement motivation. Adolescence. 2004;39:167-177.
38、 Cunningham R, Walton MA, Weber JE, O’Broin S, Tripathi SP, Maio RF, Booth BM. One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine –associated chest pain, Ann Emerg Med. 2009;53:310-320.
39、 Rouse BA. Epidemiology of illict and abused drugs in the general population, emergency department drug-related episode, and arrestees. Clin Chem. 1996;42:1330-1336.
40、 Schermer CR, Winsner DH. Methamphetamine use in trauma patients: a population-based study. J Am Coll Surg. 1999;189:442-449.
41、 Steele MT, Westdorp EJ, garza AG, et al. Screening for stimulant use in adult emergency department seizure patients. J Toxicol-Clin Toxicol. 2000;38:609-613.
42、 Seidler D, Schmeiser-Rieder A, Schlarp O, Laggner AN. Heroin and opiate emergencies in Vienna: analysis at the municipal ambulance service. J Clin Epidemiol. 2000;53:734-741.
43、 Shiffman S, Balabanis M. Associations between alcohol and tobacco. 1995;17-36.
44、 Substance Abuse and Mental Health Services Administration. Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Office of Applied Studies, Department of Health and Human Services. 2007; 07-42.
45、 Yang CC, Wu JF, Ong HC, et al. Taiwan National Poison Center: Epidemiologic data 1985-1993. J Toxicol-Clin Toxicol. 1996;34:651-663.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊