- 學位論文
思覺失調症住院病人肺炎危險因子預測之研究
An Investigation of the Risk Factors for Prediction Pneumonia among Schizophrenia Inpatients
摘要
背景與目的：思覺失調症是最嚴重的精神障礙疾病，然而思覺失調症病人有逐年增加的趨勢，目前治療方式還是以藥物治療為主，雖然第二代抗精神病藥Clozapine有較少的椎體外徑症候群，但容易引起嚴重的副作用，包括肺炎，本論文主要研究目的在探討思覺失調症住院病人服用第二代抗精神病藥物Clozapine以及其他導致肺炎的危險因子。 材料與方法：本論文以探討思覺失調症住院病人疑似服用Clozapine與其他導致肺炎的危險因子，研究架構包含人口學變項、藥物變項、血液檢驗變項、身體症狀變項等四類變數，採用病歷回顧方式研究，蒐集對象為南部某地區精神專科醫院之住院病人。 結果與結論：本論文研究對象住院期間自2013年9月1日至2018年2月28日，經醫院所屬感染管制委員會通報人數共有217人，主診斷為思覺失調症住院病人總共有80人。羅吉斯迴歸分析結果顯示服用Clozapine藥物會導致肺炎 (β = 2.71，p ＜ .05)，併發肺炎的勝算是未服用Clozapine藥物病人的15.02倍；男性住院病人(β = 2.02，p ＜ .05)及血糖值(β = -0.13，p ＜ .05)亦為危險因子，男性併發肺炎的勝算是女性的7.55倍；血糖值每增加一個單位，併發肺炎的勝算是沒有併發肺炎的1.13倍。此外，卡方檢定結果顯示產生藥物交互作用與肺炎有關聯(χ2 = 5.20，p ＜ .05)；獨立樣本t檢定結果顯示會造成白血球數值降低 (t = -3.70，p ＜ .001) 、嗜中性白血球數值降低(t = -5.40，p ＜ .001)。本論文建議需特別注意思覺失調症男性住院病人、服用Clozapine藥物、產生藥物交互作用及密切監測血糖、白血球數值及嗜中性白血球數值以防止肺炎的發生。
並列摘要
Backgroubd and purpose: Schizophrenia regards as severe mental disorder diseases. Ever increaing patients are treated with medications mainly, though 2nd generation antipsychotic Clozapine has less extrapyramidal symptoms still left serious adverse effect, including pneumonia. This thesis focus on study of Clozapine Induced Pneumonia and other risk factors. Materials and Methods: This thesis investigate on how Schizophrenia patients after taking Clozapine and other factors might lead to pneumonia. The research main focus includes variable factors of population, medications, blood tests and physical assesments. Use study of Chart review method was used to collect inpatients from southern Taiwan mental hospital. Results and Conclusions: 217 hospitalized patients data retracted from central of disease control (CDC) archives during period of 1-9-2013 till 2-28- 2018. Logistic Regression analysis shown 80 Schizophrenia patient taken Clozapine developed penumonia (β = 2.71，p ＜ .05), 15 times more than those without; male (β = 2.02，p ＜ .05) and blood sugar (β = -0.13，p ＜ .05) also positive related which considerd as risk factors, furthermore, male pneumonia complications is 7.55 times more than female; one degree of blood sugar increment, pneumonia complications increase 1.33 times. Besides, Chi-square test results show that drug interactions are associated with pneumonia (χ2 = 5.20，p ＜ .05); Two sample t test indicated that Clozapine cause low WBC count (t = -3.70，p ＜ .001) , low neutrophil (t = -5.40，p ＜ .001). This research concluded that special attention should be given to male inpatients with schizophrenia, taking Clozapine drugs, generating drug interactions, and closely monitoring blood glucose, white blood cell count, and neutrophil numbers to prevent the development of pneumonia.
參考文獻
延伸閱讀
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