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題 名 | 睡眠障礙治療藥物與安神類科學中藥處方 併用之副作用流行病學研究(2-1)=The Pharmacoepidemiologic Analysis of the Potential Drug-herb Interaction between Finished Herbal Products and Conventional Medicines Used in the Treatment of Insomnia (2-1) |
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作 者 | 王榮德; | 書刊名 | 中醫藥年報 |
卷 期 | 28:8 2010.09[民99.09] |
頁 次 | 頁229-252 |
分類號 | 418.2131 |
關鍵詞 | 安眠藥; 中藥; 中西藥併用; 交互作用; Hypnotics; Chinese herb; Drug-herb interaction; Insomnia; |
語 文 | 中文(Chinese) |
中文摘要 | 研究目的: 失眠是所有睡眠問題中最普遍的,在美國一項失眠的流行病學研究當 中,近1/3的成年人一年中至少體驗過一次失眠。在台灣失眠也是一個相當重 要的議題,根據台灣睡眠醫學會的調查,國內有超過四分之一的人口有睡眠的問題。中藥在台灣被普遍的使用,而民眾併用中西藥的情形也十分常見。 透過健保資料庫的分析,可以針對國內失眠人口分別就其年齡層、性別,描 述失眠群族的狀態做ㄧ描述性研究,藉此可以了解國內失眠的人口結構特 徵,配合國內西藥安眠藥以及中藥安神類藥物的使用情況,可以得知哪些人 是常使用西藥安眠藥以及中藥安神類藥物的族群。針對其族群進行相關藥物 使用安全性之宣導,以及失眠相關知識的衛生教育,藉以增加民眾用藥的安 全知識,並可減少因為失眠門診所耗費的健保支出。此外研究成果可供初學 者一些具代表性科學中藥粉開方模式,以利學習並進步。或健保審查醫師或 中醫師申請健保時之參考,以減少審查爭議。 研究方法: 利用健保局申請由全民健康保險研究資料庫中2002-2004年的20萬健保 抽樣歸人檔所有健保承保資料檔為母群體,作為研究材料。再利用門診申報 ICD-9診斷碼作為選取失眠族群的依據,挑選出失眠族群進行描述性研究: 分別就不同年齡層、性別,以及健保資料庫所能提供之變項逐年描述失眠群 族。之後再針對中西藥使用情形分析進行描述型分析。 結果與討論: 在2002-2004年這三年當中,失眠族群不論是各年齡層或是不同性別都呈 現增加的情況。失眠的盛行率在女性而言比男性來的高,也會隨著年齡的增加而增加其盛行率。 所有與原發性失眠症相符的中醫門診用藥紀錄當中,最常開立的複方是 酸棗仁湯,佔所有處方次數的31.0%,其次則是加味逍遙散(21.1%)、天王補 心丹(15.7%)、柴胡加龍骨牡蠣湯(13.0%)、甘麥大棗湯(9.8%)。而最常處方的 單方則是夜交藤,佔所有處方次數的17.2%,其次則是酸棗仁(13.4%)、茯神 (9.7%)、合歡皮(9.0%)、丹參(6.7%)。進一步使用資料探勘(data mining)的方法來分析單複方之間配伍的關係。酸棗仁湯配合夜交藤使用是最常見的組合。 17,765次西醫失眠門診用藥期間有1,535次(8.6%)與中醫門診用藥並用的 情況。此次研究族群中共有662人有此情況,其中又以更年期女性佔了相當高 的比例。然而草藥-西藥的交互作用仍有待我們進一步研究以確立中藥使用的 安全性。 |
英文摘要 | Aim: Insomnia is the most prevalent sleep disorder: approximately 30–35% of adults report experiencing insomnia at least once a year in developed countries. In Taiwan, people suffer from insomnia accounted for one fourth of the totally population, according to the survey of Taiwan Society of Sleep Medicine. The objective of the project is as following: 1. describe the epidemiologic information of insomnia 2. analyze the prescription patterns of hypnotics and finished herbal products in the treatment of insomnia Method: This study used the 200,000 random sampling cohort from NHI Database 1997-2004, and they were randomly selected from 23,753,407 people who had ever been insured under the NHI from 1995 to 2000. By using the systematic sampling method, its distributions of age, sex, and utilization were representative of whole beneficiaries. The function of the 200,000 random sampling cohort is to follow up a representative crowd of whole beneficiaries longitudinally. We chose study population by using ICD-9 code, and we chose those ICD-9 code according to the diagnosis criteria of primary insomnia from DSM IV. The analysis used the SAS version 9.1software (SAS Institute Inc. Cary, NC) for data linkage and descriptive statistics of drug utilization pattern. Results and Discussion: We found that the prevalence of insomnia increases with age, and symptoms are more common in women than in men. The most five common prescribed herbal formula for primary insomnia were, in order, Suan-zao-ren-tang (31%), Jia-wei-xiao-yao-san (21.1%),Tian-wang-bu- xin-dan (15.7%), Chai-hu-jia-long-gu-mu-li-tang (13.0%), Gan-mai-da-zao-tang (9.8%). For single herb, the most frequent prescription was Ye-jiao-teng (17.2%), the other common single herbs were Suan-zao-ren (13.4%), Fu-shen (9.7%), He- huan-pi (9.0%), Dan-can (6.7%). Further analysis by using data mining, we found that the common co-scription was Suan-zao-ren-tang and Ye-jiao-teng. There are 1,535 times co-use of finished herbal products and conventional medicines of all western medicine OPD record for primary insomnia. 662 people of our study population had suffered from co-use of finished herbal products and conventional medicines, and climacteric women had a great proportion of them. Further research is needed to assess drug-herb interaction in order to secure the use of finished herbal products. |
本系統中英文摘要資訊取自各篇刊載內容。