背景與目的:民國1951年起台灣小兒麻痺病例快速增加,這些患者現多已進入中老年時期,得到小兒麻痺症後的三十至四十年間他們多缺乏運動,活動力與肌耐力比一般正常人少了許多,加上小兒麻痺患者在許多活動上的限制,因此他們是否比未罹患小兒麻痺的中年人更容易併發其他疾病是值得重視的。本研究主要目的在探討小兒麻痺患者合併症的盛行率及小兒麻痺患者與正常人合併其他病症風險的差異。期能作為提供現在已步入中年的小兒麻痺患者外,亦可以提供未來二十年後將步入中年的小兒麻痺患者之參考。 研究方法:本研究為橫斷性研究,研究對象取自國家衛生研究院全民健康保險資料庫中2,032位小兒麻痺患者及10,160位非小兒麻痺患者並參考Elixhauser (1998)所整理歸納之合併症進行相關風險之探討。在控制變項方面為病患性別、年齡、收入及都市化程度,進一步瞭解性別的差異性、年齡多寡與合併症發生有所相關,以收入及都市化程度推論城鄉差距是否會影響小兒麻痺患者的就醫行為而增加合併症的發生率,採用SAS9.0統計軟體進行小兒麻痺患者的個人特質與合併其他疾病的描述性分析與推論性統計。 研究結果:從結果發現小兒麻痺患與非麻痺患者合併充血性心力衰竭、心律失常、高血脂、缺血性心臟病、肺循環障礙、周圍血管疾病、高血壓、中風、下肢癱瘓、頭痛、其他神經系統疾病、慢性肺疾病、氣喘、糖尿病併發症、糖尿病(複雜的)、甲狀腺功能低下、腎衰竭、肝病、無出血性消化性潰瘍病、淋巴瘤、B,C型肝炎、轉移性癌、固體腫瘤無轉移、類風濕關節炎/膠原血管疾病、凝血機能障礙、肥胖、體液和電解質紊亂、失血性貧血、缺乏性貧血、精神病、憂鬱症等疾病有顯著差異,在體重下降、酒精濫用、藥物濫用則無顯著差異。 結論:小兒麻痺患者除明顯的肢體麻痺外,在各系統的合併症皆與非小兒麻痺患者有顯著差異,其中風險最高的是在神經系統方面的合併症。其次為心血管方面,包含高血壓、高血脂及充血性心臟衰竭及中風。除上述疾病之外,在血液方面,如缺乏性貧血、凝血機能障礙也是小兒麻痺患者最常合併的疾病,其風險皆為非小兒麻痺患者的三倍之多。因此,未來小兒麻痺患者就醫的主動性及合併症發生後轉介機制之建立是值得被重視的。
here has been a growing number of patients with poliomyelitis in the 1950s. These patients could develop multiple co-morbidities during their aging. The poliomyelitis patients are usually less active, have poorer endurance, and have more physical limitations would have higher comorbidity risks than general population. The goal of our study was to investigate the comorbidity risk profile among patients with poliomyelitis in Taiwan. The study used data from National Health Insurance Research Database. In total 2,032 patients with poliomyelitis and the comparison group consisted of 10,160 randomized selected patients without poliomyelitis were included in this study. As compared to controls, patients with poliomyelitis had significantly higher prevalence of congestive heart failure, cardiac arrhythmias, hyperlipidemia, ischemic heart disease, pulmonary circulation disorders, peripheral vascular disorders, hypertension, stroke, paralysis, headache, other neurological disorders, chronic pulmonary disease, asthma, uncomplicated and complicated diabetes, hypothyroidism, renal failure, liver disease, peptic ulcer disease excluding bleeding, hepatitis B or C, lymphoma, metastatic cancer, solid tumor without metastasis, rheumatoid arthritis/collagen vascular diseases, coagulopathy, obesity, fluid and electrolyte disorders, blood loss anemia, deficiency anemias, psychoses and depression than controls. No significant difference between patients with poliomyelitis and controls was observed in the prevalence of weight loss, alcohol abuse and drug abuse. The study can provide the medical personels the data regarding the comorbidity profiles. It is necessary to investigate clinical strategies in prevention and management of these co-morbidities among the patients with poliomyelitis.
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