暈針之危險因子評估

THE EVALUATION OF RISK FACTORS IN NEEDLE SICKNESS

針灸為侵入性治療，但相對安全而副作用較少，然而針刺過程中發生的「暈針」現象，在臨床絕非罕見。長期以來，國內對於暈針的風險評估一直付之闕如，亟待加以調查研究。本研究運用流行病學調查及訪談，評估暈針發作的危險因子，並探討是否有其他潛在的危險因子。由基隆長庚紀念醫院中醫科門診篩選暈針患者，採用回溯性病例對照調查的方式，探討各種變因與暈針發生的相關性，包括：人口學資料、不良反應情況、疾病史、合併用藥、家族史、菸酒史、飲食習慣、針灸不良反應既往史，並評估其相關危險因子。在9626人次的針刺治療中，共有39人發生43次暈針現象，發生率為0.4%。男女比例為5：4，平均年齡為52.82歲。統計分析結果顯示(1)合併使用benzodiazepine （BZD） 藥物(2)過去暈針史(3)坐姿體位等三項和暈針的發生相關，是發生暈針的危險因子，建議臨床上應予監控，以減少意外事件的發生，提昇中醫醫療品質。Needle sickness during acupuncture treatments happen from time to time as insufficient data was found so far in Taiwan, this study aims to investigate the incidence and to explore risk factors associated with needle sickness. A retrospective case-control study was applied to investigate the factors associated with needle sickness based on the medical records and constructed questionnaire among patients administered with acupuncture in Chang Gung Memorial Hospital. Factors included in this study were basic demographics, adverse reactions in general and to acupuncture, underlying diseases, current and history of drug medications, family history of needle sickness, life-style variables, and records of past acupuncture treatments. A total of 39 patients or 43 events out of 9,626 acupuncture treatments, 0.4% of incidence rate, was found during the study period in this medical setting. Twenty four male patients (55.8%) and nineteen female patients (44.2%) were found in the needle sickness group. The average age of needle sickness cases was found as 52.82 years old. Factors found to be higher in the occurrence of needle sickness included past experience of needle sickness, sitting posture as opposed to supine position, and medications with benzodiazepine (BZD) drug. The risk factors identified by this study were shown to be preventable upon acupuncture treatments. An effective screening strategy is suggested from this study to avoid the occurrence and the subsequent accidents derived from needle sickness. A supine position is suggested for patients to be treated in acupuncture. Possible interventions are to be designed for high risk patients such as history of needle sickness and BZD drug medications.