| 摘要: | 研究目的：過去的研究顯示服用安眠藥與意外事件、髖關節骨析的發生息息相關，失眠患者害怕長期依賴鎮靜安眠藥，轉而尋求中醫藥的治療與日遽增。本研究目的主要探討台灣失眠族群在罹患失眠後，尋求中西醫藥療法的使用概況與影響中藥併用西藥安眠藥的主要因素以及最常與安眠藥併用的中藥處方。本研究結果可作為未來安眠藥與中藥交互作用研究的參考。研究方法：本研究以2002-2008年100萬健保抽樣歸人檔中，以西醫之主次診斷碼為失眠的患者為對象做描述型分析，同時，針對年齡、投保地區、投保金額及主要診斷疾病別描述其中醫藥療法的使用情形，並探討失眠患者的人口特質及社經特性對其接受中醫藥療法的影響，並分析其常合併使用中西醫之藥品種類及處方開立之模式。除此之外，更進一步利用個案對照(case-control)研究設計做因果型分析，分析髋關節骨折與服用安眠藥及中藥之因果關係。研究結果：在研究期間共收錄118,848位失眠的個案，平均年齡為44.4歲， 88.6%的失眠病患曾尋求中醫藥療法的協助，在所有失眠病患中， 27.4%的失眠病患(25,907)同時合併服用安眠藥與中藥。其中，台灣中部地區比其他地區患者具有較高的併用風險；使用多種鎮靜安眠西藥者較僅服單一安眠西藥的病患呈現較高的併用風險。髖關節骨折、交通事故、低收入的失眠病患，有增加併用安眠藥與中藥的趨勢，但皆未達統計顯著意義。失眠病患求治於中醫時，主要以症狀、體徵及不明狀況及神經系統及感覺器官疾病等相關的診斷為主，並且以服用中藥為主要治療的模式。這些在研究期間開立科學中藥處方的門診治療個案，最常合併使用的安眠藥與中藥為zolpidem 與酸棗仁湯。 另外本研究收集了2002-2008間2,591位髖關節骨折個案，以病例對照研究法分析發現，服用zolpidem、合併使用長效與短效型benzodiazepine的個案，均呈現顯著增加髖關節骨折的風險。另外，在控制各種干擾因素後發現，服用含酸棗仁中藥方劑的族群相較於未服用之族群，有稍微增加髖關節骨折的發生風險，但未達統計意義 (OR: 1.02, 95% CI: 0.89 to 1.12)。結論：本研究發現國人有一定比例併用安眠藥與中藥的現象，而使用中醫藥族群較不使用者，顯示較低的髖關節骨折發生風險。然而，進一步分析，結果顯示使用中醫藥族群中服用含酸棗仁的族群，相較於未服用含酸棗仁族群，雖未達統計意義，但顯示稍微增加髖關節骨折發生風險的趨勢。未來有待累積更大量的研究族群，以進一步評估服用含酸棗仁中藥方劑或其與安眠藥併用的安全性及療效。
Objective:Although sedative-hypnotic drugs are effective in treating insomnia, their subsequent toxicities and potential for abuse, addiction, and development of tolerance and dependence have remained for each individual drug that became available for use. Not surprisingly, Traditional Chinese medicine (TCM) remedies have co-prescribed with sedative-hypnotic drugs by TCM doctors intending to avoiding addiction or at least reducing the dose taken for trouble falling asleep among patients who are dependent on sleep tablets. The aim of the study is to explore the demographics and utilization patterns between Chinese herbal products (CHPs) users and non-users among people with insomnia and to determine how frequent the concurrent use of sedative-hypnotic drugs with CHPs on a nationwide level in real practice. We believe that this study provides evidence-based information for formulating appropriate management strategies of drug safety and integrative medicine. Methods: The usage, frequency of services, and CHP prescribed among insomniac patients using sedative-hypnotic drugs were evaluated, recruited from a randomly sampled cohort of 1,000,000 beneficiaries from the National Health Insurance Research Database. The logistic regression method was employed to estimate the odds ratios (ORs) for the co-prescription of a CHP and sedative-hypnotic drugs (CH+SH). In addition, to investigate the risk of consuming Suan Zao Ren, incident cases of hip fracture (N =2,591) and population controls (N = 557,880) were interviewed during 2002 to 2008 regarding their risk of hip fractures. ORs and 95% confidence intervals (95% CIs) were estimated by logistic regression adjusted for numerous hip fracture risk factors. Results: 88.6 percent ( N=105,259) of sleep sufferers utilized traditional Chinese medicine (TCM), 27.4% of them co-prescribed a sedative-hypnotic drug with Chinese herbal products during the 7-year study period. Females, regular salary earners, and living in Central and Southern Taiwan were more likely to consume a CHP and a sedative-hypnotic drug concurrently. Among concurrent users, “symptoms, signs, and ill-defined conditions” (32.7%, n=12,873) was the most frequent major disease category for concurrent use a sedative-hypnotic drug and CHP. Zolpidem and Suan Zao Ren Tang (Zizyphus Combination) is the most prescribed sedative-hypnotic drug and Chinese formula, respectively.In comparison with control group, the utilization of traditional Chinese medicine was significantly associated with a reduced hip fracture risk (OR 0.90, 95% CI 0.81 to 0.99), whereas the utilization of Suan Zao Ren-containing herbal products was associated with a slightly increased risk, although not significant. (OR 1.02, 95% CI 0.89 to 1.12). Conclusion: Suan Zao Ren (Zizyphus Combination) which was reported to have potential sedative effects for insomnia is the most frequently co-prescribed with a sedative-hypnotic drug and the herb-drug interactions should be taken into account by healthcare providers |
