跳到主要內容

臺灣博碩士論文加值系統

(18.204.48.64) 您好!臺灣時間:2021/07/30 10:21
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

我願授權國圖
: 
twitterline
研究生:簡婉郁
研究生(外文):Wan-Yu Chien
論文名稱:住院兒童與青少年接受安眠鎮靜藥物處方型態分析
論文名稱(外文):Prescription Patterns of Sedatives-Hypnotic Drugs in Hospitalized Pediatric and Adolescent patients
指導教授:黃文鴻黃文鴻引用關係蔡憶文蔡憶文引用關係
指導教授(外文):Weng-Foung HuangYi-Wen Tsai
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:衛生福利研究所
學門:醫藥衛生學門
學類:公共衛生學類
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:81
中文關鍵詞:安眠鎮靜藥物青少年兒童住院處方型態
外文關鍵詞:Hypnotics-sedativespediatric and adolescent patientshospitalization
相關次數:
  • 被引用被引用:0
  • 點閱點閱:332
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
背景:常見引起兒科病人產生不良反應的藥物之一即為安眠鎮靜藥物,而這類藥物於兒童與青少年多為標示外(off label)或未授權(unlicensed)的使用方式,導致各科別所開立的處方型態差異非常大。
目的:瞭解影響住院兒童及青少年接受安眠鎮靜藥物的可能因素,及有使用者其所接受的處方型態。
研究方法:本研究使用2005年全民健康保險資料中5%系統抽樣檔進行分析,研究對象為當年度所有年齡低於18歲的住院兒童與青少年共41,114人次;研究藥品為健保給付用藥品項檔內屬安眠、鎮靜劑所有藥品,包括Benzodiazepine、NonBenzodiazepines、Barbiturates、Propofol藥物。依據其住院期間內用藥狀況,區分為使用組(2556人次)與無使用組(38558人次),並以邏輯式迴歸探討影響研究對象被開立安眠鎮靜藥物使用之相關影響因素。針對有使用者,則以多變項邏輯式迴歸及序位邏輯式迴歸分析,分別探討影響使用者其被開立藥品所屬劑型別(短、中、長)及使用品項數多寡(1種、2種、3種以上)之相關影響因素。
研究結果:住院兒童與青少年被開立安眠鎮靜藥物使用的比率為6.26%,常見開立的藥品依序為Midazolam(31.7%)、Phenobarbital(18.83%)、Diazepam(14.59%)、Lorazepam(14.48%)、Propofol(5.31%)、Zolpidem(4.59%)。病人疾病別為精神疾患(OR:42.47, 95%CI:33.57~53.57)、神經及感覺器官疾病(OR:3.46, 95%CI:2.84~4.21)者較易被開立安眠鎮靜藥物使用。病人患神經及感覺器官疾病者(OR:2.51, 95%CI:1.36~4.64)較易被開立中效劑型藥物使用;病人患神經及感覺器官疾病(OR:1.78, 95%CI:1.18~2.71)較易被開立長效劑型藥物使用。病人患精神疾患(OR:5.01, 95%CI:3.23~7.75)、神經及感覺器官疾病(OR:1.52, 95%CI:1.05~2.21)者都較易被開立多種安眠鎮靜藥物使用。
結論:病人本身的特質、就醫機構的特質及醫療利用情形,顯著影響病人被開立安眠鎮靜藥物使用的機率及所接受的藥品處方型態,而控制其他影響因素後,精神疾患及神經與感覺疾患病人與接受安眠鎮靜藥物有顯著關聯,亦會影響其所接受的藥物處方型態,為安眠鎮靜藥物的高利用族群。
Background: Hypnotics-sedatives are commonly associated with drug adverse reactions in pediatric patients. The prescription patterns were various due to the off label and unlicensed use for children and adolescent.
Purpose: The aim of the study was to explore influencing factors and prescription patterns of hypnotics-sedatives for hospitalized pediatric and adolescent patients.
Methods: The study was based on 2005 randomized representatively sampled datasets released by the Bureau of National Health Insurance. Patients were selected if they were≦18 years old and hospitalized during study period, a total count of 41,114 hospitalization was derived. The target drugs were classified according to their Anatomical Therapeutic Chemical Classification as benzodiazepines, nonBenzodiazepines, barbiturates and propofol. We assessed factors associated with prescriptions of hypnotics-sedatives using logistic regression. Multinomial logistic regression and ordinal logistic regression were used to explore relevant factors influencing the prescription patterns.
Results: Overall, 6.26% of hospitalizations of pediatric and adolescent patients received prescriptions of hypnotics-sedatives. Midazolam was the most frequently prescribed drug (31.7%), followed by Phenobarbital (18.83%), diazepam (14.59%), lorazepam(14.48%), Propofol(5.31%) and zolpidem(4.59%). Psychiatric disorders(OR: 42.47, 95%CI:33.57~53.57) and neurological diseases(OR: 3.46, 95%CI:2.84~4.21) were significantly associated with hypnotics-sedatives prescribed. Patients with neurological diseases were more likely to receive intermediate acting (OR: 2.51, 95%CI:1.36~4.64) and long acting (OR: 1.78, 95%CI:1.18~2.71) hypnotics-sedatives. Patients with psychiatric disorders(OR: 5.01, 95%CI:3.23~7.75) and neurological diseases(OR:1.52, 95%CI:1.05~2.21)were more likely to receive prescriptions with multiple types of hypnotics-sedatives.
Conclusion: Prescription patterns of hypnotics-sedatives were affected by patients’ demographic characteristics, medical conditions, service utilization and hierarchy of the hospital where patients attended. After controlling other factors, prescription patterns of hypnotics-sedatives were strongly associated with psychiatric and neurological condition, patients with those diseases were more inclined to receive hypnotic-sedative medications.
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 2
第三節 研究問題 3
第二章 文獻探討 3
第一節 安眠與鎮靜 3
第二節 安眠鎮靜藥物的種類 7
第三節 安眠鎮靜藥物的實證研究 10
第三章 研究方法 15
第一節 研究設計 15
第二節 研究架構 16
第三節 研究工具 18
第四節 資料來源與個案選取 20
第五節 研究變項定義及測量 21
第四章 研究結果 31
第一節 研究對象依使用安眠鎮靜藥物有無分組於各研究特質分佈 31
第二節 安眠鎮靜藥物處方開立型態描述 37
第三節 各藥品開立次數與其所佔百分比分佈及排名 53
第四節 住院兒童及青少年接受安眠鎮靜藥物有無之相關因素分析 57
第五節 安眠鎮靜藥物所使用的劑型別與各研究特質之相關因素分析61
第六節 影響安眠鎮靜藥物者使用品項總數多寡分組之序位 67
邏輯式迴歸分析 67
第五章 討論 72
第一節 研究結果之討論 72
第二節 研究方法討論 76
第三節 研究限制 77
第六章 結論與建議 78
第一節 結論 78
第二節 建議 79
參考文獻 80
1.McIntyre J, Conroy S, Avery A, et al. Unlicensed and off label prescribing of drugs in general practice. Archives of Disease in Childhood 2000;83:498-501.
2.Kaushal R, Bates DW, Landrigan C, et al. Medication errors and adverse drug events in pediatric inpatients.[see comment]. JAMA 2001;285:2114-20.
3.Schirm E, Tobi H, de Jong-van den Berg LT. Risk factors for unlicensed and off-label drug use in children outside the hospital. Pediatrics 2003;111:291-5.
4.Palermo TM, Koren G, Blumer JL. Rational pharmacotherapy for childhood sleep disturbances: Characteristics of an ideal hypnotic. Current Therapeutic Research 2002;63:B67-B79.
5.Meyer S, Grundmann U, Gottschling S, Kleinschmidt S, Gortner L. Sedation and analgesia for brief diagnostic and therapeutic procedures in children. European Journal of Pediatrics 2007;166:291-302.
6.Meltzer LJ, Mindell JA, Owens JA, Byars KC. Use of sleep medications in hospitalized pediatric patients. Pediatrics 2007;119:1047-55.
7.Krauss B, Green SM. Procedural sedation and analgesia in children. The Lancet 2006;367:766-80.
8.Owens JA, Palermo TM, Rosen CL. Overview of current management of sleep disturbances in children: II—Behavioral interventions. Current Therapeutic Research 2002;63:38-52.
9.Kain ZN, Mayes LC, Bell C, Weisman S, Hofstadter MB, Rimar S. Premedication in the United States: a status report. Anesth Analg 1997;84:427-32.
10.Cravero JP, Blike GT. Review of pediatric sedation. Anesthesia & Analgesia 2004;99:1355-64.
11.林信男。睡眠障礙症之藥物治療。台灣醫學 2000;4:687-93。
12.吳家璇、張家銘、張憶壽等人。台灣安眠類藥品使用盛行率以及相關後遺症之研究。行政院衛生署管制藥品管理局。2007:1-70。
13.Stojanovski SD, Rasu RS, Balkrishnan R, Nahata MC. Trends in medication prescribing for pediatric sleep difficulties in US outpatient settings. Sleep 2007;30:1013-7.
14.蘇東平。睡眠障礙之診斷分類及臨床評估。台灣醫學 2000;4:665-72。
15.Owens JA, Babcock D, Blumer J, et al. The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. Journal of Clinical Sleep Medicine 2005;1:49-59.
16.Mindell JA, Emslie G, Blumer J, et al. Pharmacologic management of insomnia in children and adolescents: consensus statement. Pediatrics 2006;117:e1223-32.
17.Redeker NS. Sleep in acute care settings: an integrative review. Journal of Nursing Scholarship 2000;32:31-8.
18.Muzet A. Environmental noise, sleep and health. Sleep Medicine Reviews 2007;11:135-42.
19.Glaze DG, Rosen CL, Owens JA. Toward a practical definition of pediatric insomnia: Elsevier; 2002.
20.Kohrman MH, Carney PR. Sleep-related disorders in neurologic disease during childhood. Pediatric Neurology 2000;23:107-13.
21.Stein MA, Mendelsohn J, Obermeyer WH, Amromin J, Benca R. Sleep and behavior problems in school-aged children. Pediatrics 2001;107:E60.
22.Labellarte MJ, Ginsburg GS, Walkup JT, Riddle MA. The treatment of anxiety disorders in children and adolescents. Biological Psychiatry 1999;46:1567-78.
23.Kuppenheimer WG, Brown RT. Painful procedures in pediatric cancer: A comparison of interventions. Clinical Psychology Review 2002;22:753-86.
24.Cengiz M, Baysal Z, Ganidagli S. Oral sedation with midazolam and diphenhydramine compared with midazolam alone in children undergoing magnetic resonance imaging. Paediatric Anaesthesia 2006;16:621-6.
25.Krauss B, Green SM. Sedation and analgesia for procedures in children. New England Journal of Medicine 2000;342:938-45.
26.Calipel S, Lucas-Polomeni MM, Wodey E, Ecoffey C. Premedication in children: hypnosis versus midazolam. Pediatric Anesthesia 2005;15:275-81.
27.Hoffman GM, Nowakowski R, Troshynski TJ, Berens RJ, Weisman SJ. Risk reduction in pediatric procedural sedation by application of an American Academy of Pediatrics/American Society of Anesthesiologists process model. Pediatrics 2002;109:236-43.
28.陳思萍、王郁青、余淑美等人。實用藥理學:華杏;2005。
29.沈武典。21世紀臨床精神藥物動力學:合記書局;2002。
30.楊寶峰、蘇定馮、王美玲。藥理學。台北市:九洲;2004。
31.許若嵐、林明慧、蔡世仁。Benzodiazepine 的臨床運用。基層醫學 2004;19。
32.Reed MD, Findling RL. Overview of current management of sleep disturbances in children: I—Pharmacotherapy. Current Therapeutic Research 2002;63:18-37.
33.鄭懿之、曾美智、李宇宙等人。Zolpedem 引起輕躁狀態及其相關SPECT結果。台灣醫學 2002;6:700-4。
34.Ivanenko A, Barnes ME, Crabtree VM, Gozal D. Psychiatric symptoms in children with insomnia referred to a pediatric sleep medicine center. Sleep Medicine 2004;5:253-9.
35.Miyamoto M, Hirata K, Miyamoto T, Iwase T, Koshikawa C. Hypnotic prescriptions in a university hospital: Analysis of data from the computer-ordering system. Psychiatry and Clinical Neurosciences 2002;56:305-6.
36.Owens JA, Rosen CL, Mindell JA. Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics 2003;111:e628-35.
37.About the ATC/DDD system. WHO, 2008/04/11. (Accessed at http://www.whocc.no/atcddd/.)
38.Pelayo R, Dubik M. Pediatric Sleep Pharmacology. Seminars in Pediatric Neurology 2008;15:79-90.
39.住院醫療費用清單明細檔(DD)及住院醫療費用醫令清單明細檔(DO)之抽樣方法。國家衛生研究院,2008/03/21。 (Accessed at http://www.nhri.org.tw/nhird/date_01.htm.)
40.ICD-9-CM. World Health Organization, 2008/4/20. (Accessed at http://icd9cm.chrisendres.com/icd9cm/index.php.)
41.Mencia SB, Lopez-Herce JC, Freddi N. Analgesia and sedation in children: practical approach for the most frequent situations. J Pediatr (Rio J) 2007;83:S71-82.
42.Michael HK, Paul RC. Sleep-related disorders in neurologic disease during childhood. Pediatric neurology 2000;23:107-13.
43.Seiler G, De Vol E, Khafaga Y, et al. Evaluation of the safety and efficacy of repeated sedations for the radiotherapy of young children with cancer: a prospective study of 1033 consecutive sedations. International Journal of Radiation Oncology • Biology • Physics 2001;49:771-83.
44.Kotzer AM. Factors Predicting Postoperative pain in children and Adolescents Following Spine Fusion. Issues in Comprehensive Pediatric Nursing 2000;23:83-102.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top