健保安寧末期病患緩和鎮靜利用之探討

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Title:	健保安寧末期病患緩和鎮靜利用之探討 A population based study of palliative sedation for hospice patients with terminal illness in Taiwan
Authors:	陳莠諠
Contributors:	嘉南藥理科技大學：醫療資訊管理研究所楊美雪
Keywords:	緩和鎮靜末期病患安寧 palliative sedation therapy terminal patients hospice
Date:	2011
Issue Date:	2011-10-26 15:41:58 (UTC+8)
Abstract:	目的：了解國內安寧末期病患緩和鎮靜使用情形，並探討緩和鎮靜對末期病患存活之影響。方法：回溯性描述2005年健保抽樣歸人檔之2005年至2009年間安寧末期病患緩和鎮靜之使用情形。運用Kaplan-Meier進行有無緩和鎮靜病患之存活分析。結果：研究期間安寧末期病患有275人，使用類鴉片藥物、抗精神病藥物與/或鎮靜安眠藥物的緩和鎮靜病患有248位(90.2%)。在248人中，使用類鴉片藥物的末期病患最多有232人(93.5%)，抗精神病藥物與鎮靜安眠藥物則比較少分別有122人(49.2%)與115人(46.4%)。末期病患常使用的緩和鎮靜藥物為morphine有212人(85.5%)，haloperidol有103人(41.5%)與midazolam有76人(30.6%)。有緩和鎮靜之末期病患的平均存活時間為18.3天比無緩和鎮靜之末期病患的8.4天長，且其存活曲線顯著高於無緩和鎮靜的病患(log rank test p=0.002)。結論：本研究發現末期病患之緩和鎮靜以緩解疼痛為主，緩和鎮靜對於病患末期生命並無負面的影響。 Objective: To describe the utilization of palliative sedation therapy (PST) among hospice patients with terminal illness and examine the effect of on survival in terminally ill patients. Methods: The study conducted a descriptive retrospective study based on the Taiwan Longitudinal Health Insurance Database (LHID) from 2005 to 2009 of a systematic sample of hospice patients. Comparative survival analysis was performed using the Kaplan-Meier method with log-rank tests. Results: During the study period, 275 hospice patients with terminal illness were recorded of which 248 patients (90.2%) were administered opioids, antipsychotics and/or hypnotics and sedatives. Out of these, the drugs used for PST were opioids in 232 (93.5%), antipsychotics in 122 (49.2%) and hypnotics and sedatives in 115 (46.4%). The most common drug used was morphine (85.5%). Haloperidol and midazolam were used by 41.5% and 30.6% of the PST patients respectively. Patients who received PST had a longer mean survival (18.3 days) than those who did not received PST (8.4 days). The mortality rate derived from the Kaplan-Meier curve was higher in PST patients than no-PST patients (log-rank test p=0.002). Conclusion: The results find that the majority of terminally ill cancer patients used PST for the control of pain and PST did not have a negative effect on patient survival time.
Relation:	校內校外均不公開，學年度：99，84頁
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Dissertations and Theses

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