本文關(guān)鍵詞：探討臺(tái)灣地區(qū)大腸癌患者使用中醫(yī)之處方模式及存活分析　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 健保數(shù)據(jù)庫 Cox proportional hazards model 風(fēng)險(xiǎn)值比 共病指數(shù) 中醫(yī)醫(yī)療行為 輔助醫(yī)學(xué)

【摘要】：目的：臺(tái)灣地區(qū)自1995年3月1日開始實(shí)施全民健康保險(xiǎn),為強(qiáng)制性保險(xiǎn)的福利政策,以全體居民為保障對(duì)象,擁有完善的病人健康保險(xiǎn)就醫(yī)數(shù)據(jù),同時(shí)亦開放研究單位及學(xué)者利用此健保數(shù)據(jù)庫,以流行病學(xué)角度進(jìn)行相關(guān)分析研究。本研究利用健康保險(xiǎn)數(shù)據(jù)庫,探討臺(tái)灣地區(qū)接受中醫(yī)醫(yī)療行為之大腸癌病人,其門診常用處方用藥特點(diǎn)與治療成效,以作為未來中西醫(yī)療并治之參考。方法：本研究以2005年承保抽樣歸人文件資料6((longitudinal health insurance database [LHID]), LHID2005),為研究資料,其內(nèi)容是以2005年承保數(shù)據(jù)文件中「在保者」隨機(jī)取100萬人,擷取其各年度就醫(yī)資料建置而成。以大腸癌患者(ICD-9-CODE153、154)為研究對(duì)象進(jìn)行數(shù)據(jù)篩選,擷取這些病人門診就醫(yī)數(shù)據(jù)與中藥使用記錄,將其分成有使用中醫(yī)醫(yī)療行為與無使用中醫(yī)醫(yī)行為二組進(jìn)行數(shù)據(jù)分析。中醫(yī)醫(yī)療使用行為者定義：經(jīng)大腸癌確診后,有第一次中醫(yī)就醫(yī)紀(jì)錄開始(含)計(jì)算,連續(xù)三個(gè)月內(nèi)曾有3次以上中醫(yī)就醫(yī)紀(jì)錄者,列為有使用中醫(yī)醫(yī)療行為者。數(shù)據(jù)使用SAS for windows 13.0版軟件進(jìn)行統(tǒng)計(jì)分析,比較二組在性別、年齡、共病指數(shù)及門診常用中醫(yī)處方用藥的情形,并以Cox proportional hazards model比較,使用中醫(yī)醫(yī)療行為者,在存活率上是否有所差異,并計(jì)算其相對(duì)風(fēng)險(xiǎn)率。結(jié)果：研究結(jié)果顯示：2000-2011年臺(tái)灣地區(qū)大腸癌發(fā)生率,介于每十萬人口34.2至64.6之間且有逐年往上升的趨勢(shì),其中約有45.51%的大腸癌病人有使用中醫(yī)醫(yī)療行為。由人口學(xué)特性來看,男性使用中醫(yī)醫(yī)療行為者比女性多,約為女性的1.2倍,年長者對(duì)中醫(yī)醫(yī)療的認(rèn)同度較高。兩組死亡發(fā)生比為0.4,具有統(tǒng)計(jì)學(xué)差異(p-value0.001)。以Cox proportional hazards model進(jìn)行多變量存活分析,結(jié)果顯示大腸癌的病人使用中醫(yī)醫(yī)療行為者與無使用中醫(yī)醫(yī)療行為者,兩組相對(duì)風(fēng)險(xiǎn)值比(hazard ratio;HR)為0.37(信賴區(qū)間：0.29-0.47),達(dá)到統(tǒng)計(jì)學(xué)差異(p0.001) 經(jīng)調(diào)整性別及共病指數(shù)的影響之后,發(fā)現(xiàn)有中醫(yī)醫(yī)療行為者比沒有中醫(yī)醫(yī)療行者其相對(duì)死亡風(fēng)險(xiǎn)較低。中醫(yī)門診最常使用的單方藥前三位為丹參(1.93%)、延胡索(1.92%)、大黃(1.67%)；而單方前20位使用量共占總單方使用的27.01%。使用中藥制劑復(fù)方前3位為香砂六君子(2.42%)、疏經(jīng)活血湯(2.42%)、芍藥甘草湯(2.13%)。復(fù)方前20位使用量共占總復(fù)方使用的33.66%。整體使用中藥制劑功能前3位為補(bǔ)養(yǎng)劑(14.68%)、和解劑(8.77%)、清熱瀉火劑(8.5%)。結(jié)論：臺(tái)灣地區(qū)大腸癌治療仍是以西醫(yī)為主,然而有使用中醫(yī)醫(yī)療能增加機(jī)體整體抗病力,提高存活率。本研究結(jié)果可以作為中醫(yī)藥治療大腸癌相關(guān)研究及臨床應(yīng)用之參考。
[Abstract]:Objective: since March 1st 1995, Taiwan has implemented the national health insurance, which is the welfare policy of compulsory insurance. It takes all residents as the protection object and has the perfect patient health insurance data. At the same time, we also open the research units and scholars to make use of the health insurance database to carry out the related analysis and research from the perspective of epidemiology. This study uses the health insurance database. Objective: to explore the characteristics and efficacy of prescriptions for colorectal cancer patients in Taiwan who received traditional Chinese medicine (TCM). As a reference for future Chinese and western medical treatment. Methods: in this study, a sample of insurance coverage was collected on 2005. Longitudinal health insurance database. [LHID, LHD 2005, for research data, its content is to take 1 million people randomly from the underwriting data file of 2005. The data were collected from each year and selected from patients with colorectal cancer (ICD-9-CODE1534). The data of outpatient visits and records of the use of traditional Chinese medicine (TCM) were obtained. It is divided into the use of TCM medical behavior and non-use of TCM medical behavior two groups for data analysis. TCM medical use behavior definition: after the diagnosis of colorectal cancer, there is the first time of TCM medical records start (including) calculation. For three months in a row, the patients who had more than 3 visits to TCM were listed as the users of TCM medical behavior. The data were analyzed by SAS for windows 13.0 software. The sex, age, index of syndromes and prescriptions of traditional Chinese medicine were compared between the two groups, and Cox proportional hazards model was used to compare the two groups. Results: the results showed that the incidence of colorectal cancer in Taiwan area from 2000 to 2011 was higher than that in Taiwan from 2000 to 2011. Between 34.2 and 64.6 per 100,000 population, there is a rising trend year by year, of which about 45.51% of colorectal cancer patients have the medical behavior of traditional Chinese medicine, according to demographic characteristics. Men used TCM medical behavior more than women, about 1.2 times as female, the elderly have a higher degree of recognition of TCM treatment. The death rate of the two groups is 0.4. Cox proportional hazards model was used for multivariate survival analysis. The results showed that the relative risk value of the two groups was higher than that of hazard ratio in patients with colorectal cancer who used traditional Chinese medicine (TCM) medical behavior and those who did not use traditional Chinese medicine (TCM). HRwas 0.37 (trust region: 0.29-0.47, P 0.001). After adjusting the effect of gender and co-disease index, HRwas 0.37 (trust region: 0.29-0.47). It was found that the relative risk of death was lower for those with TCM medical behaviors than for those without TCM practitioners. The first three most frequently used single prescription drugs in TCM outpatient clinic were Salvia miltiorrhiza 1.93 and Yanhusuo 1.92). Rhizoma et Rhizoma Rhei 1.67; And the first 20 usage of single prescription accounted for 27.01 of the total single prescription. The top 3 of using Chinese traditional medicine preparation compound were Xiangsha six gentlemen 2.42dick, and thinning Meridian Huoxue decoction 2.42). Paeoniao Licorice decoction was 2.130.The usage of the first 20 compounds accounted for 33.66kum of the total compound. The top 3 of the function of the whole use of traditional Chinese medicine preparation was the nourishing agent (14.68m). Conclusion: the treatment of colorectal cancer in Taiwan is still mainly western medicine, but the use of traditional Chinese medicine can increase the overall anti-disease ability of the body. The results of this study can be used as a reference for the study and clinical application of traditional Chinese medicine in the treatment of colorectal cancer.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R273

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