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  • 學位論文

服用statins降血脂藥急診就醫者處方型態分析

Analysis of using statins related prescription patients served in emergency department

指導教授 : 徐尚為
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摘要


本研究之目的在於分析服用3-Hydroxy-3-methylglutaryl coenzyme A Reductase Inhibitor(HMG CoA還原酶抑制劑,簡稱statins)降血脂藥物急診就醫者之特性、急診原因、statins降血脂藥物使用情形,以及處方中是否有潛在藥物交互作用(Potential drug interactions, PDIs)之用藥情形、就醫場所等,以作為日後有關單位推動用藥安全之參考依據。 此研究採次級資料回溯性分析法,資料來源為國家衛生研究院所提供的全民健康保險研究資料庫之2005年100萬人承保抽樣歸人檔,探討2007年服用statins降血脂藥物急診就醫者特性、急診原因、就醫場所、statins降血脂藥物使用情形等,並利用Micromedex 和Drug interaction facts瞭解服用statins降血脂藥物急診就醫者,在急診就醫前合併使用其他藥物之可能發生的潛在藥物交互作用之情形。 研究結果發現,服用statins降血脂藥物急診就醫者,男性佔52.6%、女性佔47.4%,平均年齡為69.8歲,最大年齡為89.0歲,最小年齡為17.0歲;急診主要原因為循環系統疾病(24.6%)中的本態性高血壓(3.5%)和其他心絞痛(3.5%)最多,季節因素以秋天(27.2%)為主;就醫場所最多為台北分局(64.9%);全年statins降血脂藥物使用佔58.7%,最多為atorvastatin(67.5%),合併使用其他藥物主要為sulfamethoxazole(3.5%), digoxin(3.2%)次之;急診就醫者合併使用其他藥物,可能有的潛在藥物交互作用之處方型態情形為:atorvastatin/ digoxin, atorvastatin/ fenofibrate, atorvastatin/ gemfibrozil, pravastatin/ fenofibrate, pravastatin/ gemfibrozil, lovastatin/ fenofibrate。 結論:從研究結果推測,醫師於急診看診時,除詳細詢問病人過去病史外,應了解就醫之前的用藥情形,以避免潛在藥物交互作用發生。

並列摘要


The purpose of this study is to analyze the relationship between emergency medical care and the potential drug interactions of the Statins lipid-lowering drugs user. Subjects were selected from the year 2007 National Health Insurance reimbursement database of Taiwan. The characteristics of emergency medical care and potential drug interaction were studied. The study found that 52.6% of the target population were male, age between 17.0 and 89.0, and the average age was 69.5. The main reason for emergency was circulatory system diseases (24.6%). 27.2% of the emergency cases happened in the fall. Statins accounted for 58.7% annually lipid-lowering drugs used; and atorvastatin was the most prescribed statins (67.5%). After analyzing subjects’prescription, this research found potential drug interactions prescribing patterns for the case were atorvastatin/ digoxin, atorvastatin/ fenofibrate, atorvastatin/ gemfibrozil, pravastatin/ fenofibrate, pravastatin/ gemfibrozil and lovastatin/ fenofibrate. In addition to ask medical history of emergency patiens, physicians should check previous medicine usage carefully to avoid potential drug interactions.

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