台北市中医师公会中医药研究论丛

第21大医事团体羽球联谊赛

115年针灸收针程序指引及教育训练

公会简介

261.2 中风後帕金森氏症患者接受中医治疗可减少急诊与住院医疗耗用

TJ TCM.26(1) : 13-28, 2023

DOI : 10.6516/TJTCM.202303_26(1).0002

中风後帕金森氏症患者接受中医治疗可减少急诊与住院医疗耗用

The Therapeutic Experience of Malignant Fungating Wounds in End-Stage Breast Cancer with Traditional Chinese Medicine and Acupuncture-A Case Report

吴佩芸1,2　陈朝宗1　孙茂峰3　陈大梁4,5,6　廖建彰3,5,6,7,8*

1台北市立联合医院仁爱院区中医科，台北，台湾

2义守大学医学院学士後中医学系，高雄，台湾

3中国医药大学中医学院中医系，台中，台湾

4台北市立万芳医院麻醉科，台北，台湾

5台北医学大学医学院医学系麻醉科，台北，台湾

6台北医学大学附设医院麻醉暨卫生政策研究中心，台北，台湾

7台北医学大学附设医院麻醉科，台北，台湾

8台北医学大学万芳医院大数据暨统合分析研究中心，台北，台湾

【摘要】

背景：中风患者使用中医後之疗效已多次被证实，但目前尚无证据显示中医治疗可改善中风後帕金森氏症患者之预後。本研究评估有中风病史的帕金森氏症患者接受中医治疗後是否会减少急诊及住院医疗的耗用。方法：本研究利用全民健康保险资料，筛选了2000－2007年间40岁以上初次罹患帕金森氏症且有中风病史之患者（30,373位），来建立介入性的世代研究。我们利用倾向分数进行配对，选取合适的中医治疗组（2701位）及非中医治疗组（2701位）之患者进行追踪，观察病患在追踪期间一年内的急诊及住院医疗利用，再用Cox回归模型来计算中医治疗与急诊及住院之医疗耗用的危害比（hazard ratio, HR）及95%信赖区间（confidence interval, CI）。结果：中风後帕金森氏症患者接受中医治疗後的追踪期间一年内，与没有接受中医治疗组相比，中医治疗组与减少的急诊次数（β=-0.06，p=0.0063）、住院次数（β=-0.22，p<0.0001）、住院医疗花费（β=-817.43，p=0.0001）及住院天数（β=-4.92，p=0.0006）等有关。中医治疗与减少中风相关急诊利用风险（HR=0.89，95% CI=0.81-0.99）、住院利用风险（HR=0.78,95% CI=0.73-0.83）及加护病房利用风险（HR=0.67，95% CI=0.57-0.78）有关。另外，无论是仅使用针灸（HR=0.76，95% CI=0.62-0.93）、仅使用中药（HR=0.67，95% CI=0.60-0.74）或使用针灸及中药（HR=0.67，95%CI=0.59-0.77）的组别对降低医疗耗用都有统计上的显着差异。结论：中风後帕金森氏症患者在追踪期间接受中医治疗可以减少急诊及住院的医疗耗用。建议医疗主管机关与各医疗院所可鼓励帕金森氏症患者接受中医治疗。本研究结果将有助於作为未来拟定医疗政策的叁考。

【关键词】急诊；住院；帕金森氏症；中风；中医

【Summary】

Background: It has been proved that traditional Chinese medicine (TCM) has beneficial effects on the clinical outcomes in patients with stroke. However, little was known about the effects of TCM on patients with Parkinson’s disease (PD). Our purpose is to evaluate the effect of TCM on the use of emergency care and hospitalization in patients with PD who had stroke history. Methods: Using research data of Taiwan’s National Health Insurance, we conducted a retrospective cohort study included 30,373 patients with post-stroke PD who aged over 40 years in 2000-2007. After propensity-score matching, we obtained 2,701 pairs of PD patients who had previous stroke with and without TCM treatment for comparison. Using multiple Cox proportional hazard models, we calculated the adjusted hazard ratio (HRs) and 95% confidence interval (CI) of 1-year use of emergency care and hospitalization associated with TCM treatment. Results: Among PD patients with previous stroke, those who received TCM treatment had significantly lower frequency of emergency care medical visits (β= 0.06, p=0.0063), frequency of hospitalization (β=-0.22, p<-0.0001), expenditure of hospitalization (β=-817.43, p=0.0001), and length of hospitalization (β=- 4.92, p=0.0006). The HRs of emergency care, hospitalization and intensive care associated with TCM treatment were 0.89 (95% CI 0.81-0.99), 0.78 (95% CI 0.79-0.83) and 0.67 (95% CI 0.58-0.78). In addition, only acupuncture (HR=0.76, 95% CI=0.62-0.93), only Chinese herbal medicine (HR=0.67, 95% CI=0.60-0.74) and both acupuncture and Chinese medicine (HR=0.67, 95% CI=0.59-0.77) were associated with decreased risks of emergency care visit and hospitalization. Conclusion: Among patients with post-stroke PD, TCM treatment was associated with reduced risks of emergency care visit and hospitalization. Our findings implicated that the health authority and hospitals may encourage patients with post-stroke PD to receive TCM treatment.

【Keywords】

Emergency care； Hospitalization； Parkinson’s disease； Stroke； Traditional Chinese Medicine

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