住院癌症病患鴉片類止痛劑消耗量及其影響因素 -以全民健保資料庫為例

Opioid Analgesics Consumption and Related Factors in Hospitalized Cancer Patients- An example of National Health Insurance database

余美蓮(Meei-Liam Yu)

指導教授 ： 林佳靜

臺北醫學大學/護理學院/護理學研究所/碩士(2007年)

摘要

癌症病患在住院期間疼痛發生率極高，根據統計多數病患並沒有獲得適度的疼痛治療，癌症疼痛治療不足會嚴重影響病患健康安適之功能，因此，疼痛控制是照護癌症病患的一大要務。
故本研究旨在瞭解住院癌症病患其鴉片類止痛劑消耗量及探討影響住院癌症病患鴉片類止痛劑之因素。研究方法採橫斷性研究，以2004年全民健康保險學術研究資料庫中擷取住院癌症病例，並篩選醫令有使用鴉片類止痛劑者成為研究樣本，共有163,780病例。資料分析採描述性統計、t檢定、單因子變異數分析（one-way ANOVA）、複迴歸分析（multiple regression analysis）。
研究結果顯示住院癌症病患鴉片類止痛劑消耗量以Pethidine使用人次最多，其次是口服嗎啡。將住院癌症病患所使用的鴉片類止痛劑全數依效價不同皆轉換成口服嗎啡同等劑量（oral morphine equivalent），年總消耗量為45,160,418mg；由於本研究樣本數較少，故以每千人口每日界定劑量計算DDD數值，結果2004年住院癌症病患之嗎啡消耗量為為25.3 DDDS/thousand/day。
在變異數分析結果顯示不同的病人屬性、不同的照謢醫師屬性，不同的醫院屬性與鴉片類止痛劑消耗量均有顯著性差異(P<0.001)；在複迴歸分析結果顯示整體預測因子會影響鴉片類止痛劑消耗量，達統計上顯著差異(P<0.001)。希望本研究結果能夠提供醫療專業人員及醫事機構執行癌症疼痛處置之參考，適時有效緩解癌症病患的痛苦，提升病患生活品質。

關鍵字

癌症病患 ； 鴉片類止痛劑消耗量 ； 全民健保資料庫

並列摘要

Pain is the most prevalent symptom in the majority of patients with cancer during hospitalization. Many of patients have not received adequate pain treatments.Inadequate pain management may compromise well being of the patients; therefore, pain control must be one of the priorities in caring for cancer patients.
This study explored opioid analgesics consumption and related factors in hospitalized cancer patients . Cross-sectional design is used in is study . Hospitalized cancer patients using opioid drugs registered in the“2004 National Health Insurance Research Database” are selected as the study population. There are totally 163,780 cases. Descriptive analysis, t test, one-way ANOVA, and multiple regression analysis are used for data analysis.
Rsults from this study indicate that pethidine is the most commonly used opioid for hospitalized cancer patients, with oral morphine being the second. The total morphine equivalent doses consumed annually by hospitalized cancer patients sum up to 45, 160,418mg. Because of the modest sample size, we present the DDD (defined daily dose) by per thousand patients. In this way, the hospitalized cancer patients of 2004 consumed 25.3 DDDs/thousand/day of morphine.
The results of ANOVA show that patient, physician, and hospital characteristics significantly influence the opioid consumption (P <0.001). The result of multiple regression analysis also reveals that predictive factors affect the opioid usage (P<0.001). Hopefully this survey may serve the medical personnel and institutions as reference to cancer pain management, in order to improve life quality by relieving cancer pain timely and effectively for patients with cancer.

並列關鍵字

Cancer patient ； Opioid Analgesics Consumption ； National Health Insurance Research Database

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