頁籤選單縮合
| 題 名 | 利用健保資料庫分析中藥單方或複方與相關西藥合用之比率=To Analyze the NIH Database for the Frequency of Combined Use of Chinese Herbal Drugs or Acupuncture with Related Western Medicine |
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| 作 者 | 陳方佩; | 書刊名 | 中醫藥年報 |
| 卷 期 | 28:8 2010.09[民99.09] |
| 頁 次 | 頁253-290 |
| 分類號 | 413.4 |
| 關鍵詞 | 中藥; 中西藥交互作用; 健保資料庫; Chinese herbal drug; Herb-drug interaction; NHI database; |
| 語 文 | 中文(Chinese) |
| 中文摘要 | 隨著醫學科技的進展，近二十年來全球對中醫藥的需求越發普遍，臨床 上同時使用中西藥的機會也越來越高。由於病人往往認為大自然原生的藥物 比較安全，可以搭配西藥來使用，實則已知中草藥也有藥理成分。目前已有文獻報告指出有些中草藥和西藥會產生交互作用，例如大蒜和銀杏會對抗癌 藥物有作用等。在台灣，中或西醫師是分開接受不同體系的養成教育，然後分開執業。但是病人則可以自由選擇就醫科別，因此若中西醫師所開立的中 西藥之間有交互作用，不僅病人不知道，可能是中西醫師各方都會忽略的問 題。雖已成立中西藥的不良藥物反應通報系統，但有關中西藥合用方面的資 料有限，少量樣本數的問卷式分析，不足以看見全貌，應利用廣大人群進行 大規模的交互作用分析。自1996年，臺灣中西醫藥均納入全民健康保險，病 人看診的所有資料都利用電子檔做申報，本研究就是利用此資料庫連結任一 病人，在同時期所服用健保中西藥之間，可能有交互作用的發生比率，以提 供民眾用藥安全的知識和中西醫學教育之用。 利用全民健保資料庫2005和2006年的看診資料，取年滿20歲成年人， 凡有看診中醫且有看診西醫的人數的五分之一，共計388GB。先由看診中醫 檔，找出有使用某種單方者，聯結同時期看診西醫中是否有可能交互作用的 西藥，算出其比率。 2005年總共310,425人和2006年總共334,710人有看中醫和西醫診次，共 開中藥處方，2005年7,077,690張，2006年7,629,838張，其中有服用麻黃單方 及複方的處方，2005年有220,341張，和2006年214,400張，則同時期有可能 服用相關西藥，如Theophilline、ephedrine、caffeine或isoniazide的處方，2005 年及2006年分別為11,645張(5.28%)及11,314張(5.28%)，看診原因以上呼吸道 感染為主。雖國外有報導含ephedrin的麻黃會造成血壓高、心悸等問題，但國內處方中藥多不是僅用單方，而是複方形式，所以劑量不高，也較無不良反應的案例。至於使用中藥人參合併潛在性作用西藥則以合併使用Aspirin及 Dipyidamole居多，其男性佔多數，平均年齡較高，而其疾病診斷以心血管及 代謝性疾病居多。總之，中西醫師雙方，還是應注意中藥與西藥交互作用的 潛在比例，並應提醒民眾不宜擅自服用非處方藥。 |
| 英文摘要 | The use of herbal medicines (HM) is on the rise among the global population. Although the safty profile of many herbal medicine is promising, accumulated data show evidences of significant interactions with medications, which can place individual patients at great risk. Among consumers, there is widespread belief that remedies of natural origin are safe, and many patients take these natural products concomitantly with drugs prescribed by their physicians. HM affect pharmacokinetic and pharmacodynamic properties of conventional drugs and thus cause herb-drug interactions. There is no doubt that there is potential for HM to interact adversely with prescription medicines, with danger of injury and even death. However, there is not enough informnation or adequate analysis to estimate the magnitude of the problem. These data are generally insufficient to predict the incidence of herb-drug interactions. Thus, greater research, particularly by using large population samples is needed in order to avoid the problems with individual susceptibility. In Taiwan, an universal health insurance program started in 1995, covered all western medical events, and the traditional Chinese medicine (TCM) also has been covered since 1996. At the end of 2002, 97.7% of all inhabitants were included into this program. With the advantage of the available electronic form of claim data from the National Health Insurance Research (NHIR) Database for researchers interested in data mining, we are able to investigate the frequency of herb-drug interactions between both Western and Chinese medicines in Taiwan. This nation-wide database, including visit file and prescription file for each individual in each year, will be a large-enough scale of investigation. The ongoing purpose of this study is to investigate the potential impact of herb-drug interactions on patient safty and to contribute to public and scientific debate on this matter. We have purchased the electronic from of NHIR database, 2006, including the visit files and prescription files, both western medicine and TCM, of 20% adults aged over 20 years old. First, we picked up all the TCM prescriptions which contained the certain herb that was reported to have potential interactions with some western drugs. Then, we analyzed the persons who had the prescription of those western drugs during the similar period of TCM prescription. Finally, we calculated the potential ratios. Among total 310,425 persons in 2005 and 334,710 persons in 2006, who had visited both Chinese medicine and Western medicine, there were 7,077,690 total Chinese herbal prescriptions in 2005, and 7,629,838 in 2006. The herbal prescriptions containing Ma-Huang in single remedy and compound formulae were 220,341 in 2005, and 214,400 in 2006, which probably prescribed with some related western drugs, as theophyllin, ephedrine, caffeine, or isoniazid during the some period were 11,645(5.28%) in 2005, and 11,314(5.28%) in 2006. Although there were reports from abroad that the ephedrine-containing Ma Huang would induce hypertension or palpitation, etc., traditional Chinese doctors didn t prescribe herbs by single remedy, but in multiple forms. The dosage of single active component might be less than the potentially risk amount. That is why there was very few adverse herb-drug interactions reported in Taiwan. However, it is still needed to inform both Chinese and Western training doctors to pay attention to the potential existence of herb-drug interactions, and to notify patients to use prescribed medicine, not to buy the on-the-counter herbs. |
本系統中英文摘要資訊取自各篇刊載內容。