中風病人使用止痛劑之影響因子初探

Evaluation of Impact Factors on the Analgesics Consumption in Stroke Patients

張煦婕(Hsu-Chieh Chang) ； 林佳靜(Chia-Chin Lin)

《新臺北護理期刊》 20卷2期 (2018/09) Pp. 23-35

https://doi.org/10.6540/NTJN.201809_20(2).0003

摘要

中風合併失語症可能是影響中風病人疼痛控制的一大因子。本研究旨在瞭解中風病人無合併失語症與中風合併失語症病人使用止痛劑之差異，研究方法採橫斷性研究，以全民健康保險學術研究資料庫中686位中風合併失語症病人及52,598位中風無合併失語症病人，資料分析採描述性統計、t檢定、卡方檢定、及複迴歸分析，研究結果顯示中風無合併失語症病人止痛劑平均使用量顯著高於中風合併失語症病人，在注射型Keto非類固醇類抗發炎藥物平均用量顯著高於0.35毫克（t=6.50, p＜.0001）；Acetaminophen平均用量顯著高於197.69毫克（t=10.74, p＜.0001）；嗎啡平均用量顯著高於0.52毫克（t=9.19, p＜.0001）；在複迴歸分析發現注射型Keto藥物失語症病人較無無失語症病人少0.29倍（p=.02）；Acetaminophen使用量失語症病人顯著低於無失語症病人124.11倍（p=.0005）；嗎啡使用量失語症病人顯著低於無失語症病人0.52倍（p=.04）；預測中風病人使用止痛藥物量的因子包括失語症、病人年齡、疾病嚴重度、醫師屬性及醫院屬性，故此結果可作為未來針對中風合併失語症病人開立疼痛處置之參考，以提升病人生活品質。

關鍵字

失語症 ； 中風病人 ； 止痛劑使用量

並列摘要

Aphasia may have a major impact on pain control in stroke patients. The purpose of the study was to investigate the impact of aphasia on consumption of analgesics in stroke patients. A cross-sectional study design using the ＂2004 National Health Insurance Research Database＂ was undertaken. Patients were enrolled based upon records of analgesics consumption during hospitalization, including 686 patients with aphasia and 52,598 patients without aphasia. Descriptive analysis, t-test, Chi-square test, and multiple regression analysis were used for further data analysis. Results from the study showed that stroke patients with aphasia received significantly lower analgesics consumption than those without aphasia (p＜.05). The result of t-test analysis showed that consumption of all analgesics including keto, Acetaminophen, and Morphine was significantly higher in patients without aphasia than those with aphasia. However, the result of multiple regression analysis showed that consumption of keto, NSAID, and Acetaminophen was significantly higher in patients without aphasia than those with aphasia. Impact factors for analgesics consumption in stroke patients were aphasia, age, illness severity, physician subspecialty, and hospital subspecialty. This survey may serve the medical personnel and institutions as a reference for pain management to improve quality of life by relieving post-stroke pain timely and effectively in stroke patients with aphasia.

並列關鍵字

aphasia ； stroke patients ； pain medication

參考文獻

Desmaele, S., Putman, K., De Wit, L., Dejaeger, E., Gantenbein, A. R., Schupp, W., . . . De Paepe, K. (2016). A comparative study of medication use after stroke in four countries. Clin Neurol Neurosurg, 148, 96-104. doi: 10.1016/j.clineuro.2016.07.007

Hansen, A. P., Marcussen, N. S., Klit, H., Andersen, G., Finnerup, N. B., & Jensen, T. S. (2012). Pain following stroke: A prospective study. European Journal of Pain, 16(8), 1128-1136. doi: 10.1002/j.1532-2149.2012.00123.x

Harrison, R. A., & Field, T. S. (2015). Post stroke pain: Identification, assessment, and therapy. Cerebrovasc Dis, 39(3-4), 190-201. doi: 10.1159/000375397

Jonsson, A. C., Lindgren, I., Hallstrom, B., Norrving, B., & Lindgren, A. (2006). Prevalence and intensity of pain after stroke: A population based study focusing on patients' perspectives. J Neurol Neurosurg Psychiatry, 77(5), 590-595. doi: 10.1136/jnnp.2005.079145

Kim, J. S. (2014). Pharmacological management of central post-stroke pain: A practical guide. CNS Drugs, 28(9), 787-797. doi: 10.1007/s40263-014-0194-y