臺灣博碩士論文加值系統

背景：研究估計目前全球約有近五千萬人口罹患失智症，醫療成本超過8180億美元。 失智症的主要危險因素為年齡老化，預估到2050年罹患失智的人數將超過1.32億。先前已有研究顯示，失智症的病人中毒的風險性較高(Mitchell, Harvey, Brodaty, Draper, & Close, 2015)。本研究目的為以台灣健保資料庫探討失智症與發生非蓄意中毒之相關性。
方法：使用全民健康保險研究資料庫百萬歸人檔2005年版本，以2000年至2010年40歲以上，門診3次或住院1次以上的的失智症診斷患者為研究對象，排除2000年以前已有診斷失智症以及診斷失智症前即有診斷中毒、精神疾病或物質濫用或依賴者、性別不明及失智症診斷確立後追蹤時間小於六個月者；研究對象追蹤至事件發生（新診斷之非蓄意中毒）、失去追蹤、死亡或達2010年12月31日研究中止。本研究並以為罹患失智症的一般納保人為對照組。使用Cox proportional hazard regressions調整干擾變項，計算罹患失智症個案往後發生非蓄意中毒的風險，並以診斷時間、中毒物質進行分析，並以Kaplan-Meier曲線比較失智症病人組與對照組的非蓄意中毒累計發生率差異。
結果：非蓄意中毒的發生率失智症患者高於非失智症患者達2.721倍(95%C.I.=2.162-3.424，p <0.001)。經過調整控制變項後，風險比值達2.385倍(95% C.I.=1.883-3.021，p <0.001)。個案組發生鎮靜劑及安眠藥中毒的風險是對照組的3.399倍(p <0.001)；而在中樞及自主神經系統藥物方面，個案組發生中毒的風險是對照組的2.751倍(p=0.049)。
結論：失智症會顯著的提高後續發生非蓄意中毒的風險；特別是在使用鎮靜藥/催眠藥以及中樞和自主神經系統藥物兩類藥物。主要因素可能為失智症多為老年族群，使用的藥物種類及複雜性較高，伴隨著記憶能力及認知能力的逐漸變差，導致失智症患者對於在適當時間服用不同劑量的藥物產生困難及醫囑順從性不佳的問題，而提高了非蓄意中毒的可能性。相關的醫療照護團隊應針對藥物及其他物質的儲存、包裝、標籤及管理藥物幾個方面來訂立改善措施，以減少意外中毒的發生。

Background: Elderly individuals with dementia are a particularly vulnerable group and have an increased risk of poisoning. We investigated the correlation between dementia and the risk of unintentional poisoning in a retrospective, longitudinal and nationwide population-based study.
Methods: Overall, 27,438 patients with dementia were selected from the National Health Insurance Research Database of Taiwan between 1 January 2000 to 31 December 2010, and 109,752 controls were propensity score-matched by gender, age, index year, and presence of heart failure, liver disease, renal disease, and cancers. After adjustment for confounding factors, Cox proportional hazards analysis was used to compare the risk of poisoning during follow-up.
Results: Among dementia patients, 100 (0.36%) had unintentional poisoning events compared to 350 (0.32%) controls. Cox proportional hazards regression revealed that the patients were more likely to develop poisoning than the controls (hazard ratio [HR]: 2.721, 95% CI = 2.162-3.424, p < 0.001). After adjustment for sex, age, monthly income, urbanization level, geographic region, and comorbidities, the HR for poisoning was 2.385 (95% CI = 1.883-3.021, p < 0.001).
Conclusions: Patients with dementia have a high risk of unintentional poisoning, and appropriate prescription medications and careful review of dementia patient compliance are important

第一章　緒論 1
第一節　研究背景與動機 1
第二節　研究目的 3
第二章　文獻探討 4
第一節　失智症流行病學 4
第二節 失智症的表現 6
第三節 失智症的診斷 7
第四節　非蓄意中毒 8
第五節 失智症與非蓄意中毒 9
第六節 文獻總結 10
第三章　研究方法 11
第一節　研究架構 11
第二節　研究對象 12
第三節　資料來源 14
第四節　研究變項與操作型定義 15
第五節　分析方法 17
第四章　研究結果 18
第一節　描述性統計分析 18
第二節　非蓄意中毒風險的單變項及多變項分析 22
第三節　非蓄意中毒與各變項相關性分析 24
第四節　非蓄意中毒物質種類分析 27
第五節　累進發生率曲線分析 28
第五章　討論 29
第一節　主要研究結果 29
第二節 非蓄意中毒物質 30
第三節 非蓄意中毒因素探討 31
第六章　結論及建議 32
第一節　結論 32
第二節 建議 33
第三節 限制 35
參考文獻 36

 
圖目錄
圖3-1、研究架構 ...................................................................................11
圖3-2、研究對象擷取流程圖..................................................................13
圖4-1、失智症與非失智症患者的非蓄意中毒累進發生率差異.….....28


表目錄
表3-1、操作型定義 ..............................................................................15
表4-1、個案組(失智症患者)與對照組(非失智症患者)特徵之分佈.....18
表4-2、個案組(失智症患者)與對照組(非失智症患者)追蹤終點特徵之分佈..........................................................................................................20
表4-3、非蓄意中毒發生率及風險比值..................................................22
表4-4、各變項與非蓄意中毒風險相關分析..........................................25
表4-5、非蓄意中毒物質種類分析 ........................................................27

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