末期失智症之中西醫整合照護

前言：台灣失智症的盛行率逐年提高，是醫療體系與臨床醫師必須要積極面對的沉重負擔。過去研究發現，台灣的失智症患者約有三成會尋求中醫治療，且比率有逐年升高的趨勢。但是，對於末期失智症患者接受中西醫整合照護的情形，仍然缺乏詳細的臨床調查能夠提供詳盡的資訊。本研究的目的為評估末期失智症患者接受中西醫整合照護的使用率及趨勢，並探討患者選擇中西整合照護之可能因素，我們也將探尋失智末期患者需要中醫協助的症狀，以及分析常見的中醫處方模式。方法：本研究將採用橫斷性研究，以全民健康保險資料庫為研究材料，我們自2000-2012年篩選失智症患者，並依照失智患者發病後的時間與是否接受長期管路置入或居家照護，將患者分為失智症前期、中期與末期。我們依照各階段患者之就醫情形，判斷患者是否接受過中西整合醫療。我們分析社經因素（包含性別、年齡、投保金額、投保地區）與醫療因素如慢性疾病對中西醫整合使用率的影響。我們使用多項式邏輯斯迴歸模型（Multilevel Logistic RegressionModel）來評估中西醫整合醫療組與單純西醫組患者之間的差距。為了探尋失智症末期的中醫處方模式，我們會將患者所服用過的中醫處方，不論單複方自健康保險資料庫中擷取出來，並分析失智症各階段接受中醫方劑之類別分布。結果：我們分析2780位失智症患者的中西醫整合療法資料。失智症患者在中期接受中西醫整合醫療的比率最高（42.7%），初期比例（33.5%）較低，末期則最少（22.4%）。我們分析失智症各階段患者的中醫處方情形，可以發現各階段的方劑使用率彼此不同：在失智症早期階段以補養劑（16.7%）、清熱劑（10.3%）、安神劑（9.8%）最為常用；在中期則為安神劑（12.3%）、和解劑（10.5%）、利濕劑（8.3%）、袪痰劑（8.0%）的使用率最高；末期失智症最多見的方劑依序為利濕劑（13.8%）、袪痰劑（13.7%）、補養劑（11.3%）、潤燥劑（7.7%）等。結論：本篇研究發現，末期失智症患者接受中西醫整合醫療的比率仍然不高，期待透過政府與公會的推廣努力，能夠讓更多失智症患者接受高品質的整合醫療。

關鍵字

末期失智；傳統中醫；針灸；中西醫整合治療；中西藥交互作用；整合與替代醫療；精神與行為症狀

並列摘要

Objective: The prevalence of dementia increases continuously in the recent years and becomes a critical issue that the medical system and clinicians must deal with. Previous studies have showed that about 30% of the dementia patients had been treated with traditional Chinese medicine (TCM) and continue to rise. However, there are insufficient clinical studies to provide enough information about the treatments of terminal stage dementia by integrated Chinese and western medicines (ICWM). The objectives of this study were to evaluate the usage rate and the trend of using ICWM in terminal stage dementia and possible reasons for choosing the integrated treatments. We also studied the symptoms of terminal stage dementia who need TCM and the common formula patterns. Methods: This study adopted a cross-sectional design and used the National Health Insurance Research Database (NHIRD) as the source of raw data. We selected the dementia patients confirmed between 2000 to 2012 and divided them into early, middle, and terminal stage according to how long they had suffered from the disease and whether they received long term tube placement or home care. We judged whether the receival of ICWM by their medication records. We analyzed both social (including gender, age, insurance price, and insurance area) and medication factors (e.g., chronic diseases) that may affect the usage rate of ICWM system. We employed multilevel logistic regression to evaluate the difference between ICTM group and pristine Western Medicine group. To have a fundamental understanding of TCM on terminal stage of dementia, we acquired all TCM formula from the NHIRD, either single or compound, and analyzed the distribution of TCM formula used in each stage of dementia. Results: We analyzed the ICWM data from 2780 dementia patients. The usage rate of ICWM was highest (42.7%) in the medium stage, lower (33.5%) in the early stage, and lowest (22.4%) in the terminal stage. The TCM formula patterns differed across stages. Invigoration agent (16.7%), clearing heat agent (10.3%), and tranquillization agent (9.8%) were the most widely used in the early stage while tranquillization agent (12.3%), reconciliation agent (10.5%), promoting diuresis agent (8.3%), expectorants agent (8.0%) were the most widely used in the medium stage. The most common agents used in terminal stage were promoting diuresis agent (13.8%), reconciliation agent (13.7%), invigoration agent (11.3%), and moistening dryness agent (7.7%). Conclusion: This study found that the usage rate of ICWM in terminal stage dementia was low. High quality ICWM services for more dementia patients may be achieved by every endeavor and continuous promotion from our government and guild.

並列關鍵字

Terminal Stage of Dementia ； Traditional Chinese Medicine ； Acupuncture ； Integrated Chinese and Western Medicine ； Herbal-Drug Interaction ； Complementary and Alternative Medicine ； Behavior and psychological symptom of dementia

國際替代計量

末期失智症之中西醫整合照護

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