台灣全身性紅斑狼瘡婦女懷孕前就醫狀況之描述性分析

Descriptive Analysis of Medical Utilizations before Pregnancy with Systemic Lupus Erythematosus Women in Taiwan

背景：懷孕時機對紅斑狼瘡婦女來說非常重要，許多專家建議應於病情穩定達六個月以上計量懷孕，以降低自身疾病發作並促進好的妊娠結果。因此懷孕前疾病穩定性是非常重要的。目的：本研究希望透過健保資料分析患者懷孕前就醫概況，了解懷孕前疾病穩定性。方法：以全民健何資料，採回溯性方法以ICD-9:710.0為研究對象，20~40歲至少2（含）次產檢者，回溯第一次產檢前180天之門診、急診、住院及有無接受急性發作治療就醫紀錄，以SAS 9.4統計軟體進行資料處理與分析。結果：3207人次有2次（含）以上產檢，平均年齡30.4歲，前180天平均門診21.35次，急診0.53次、住院0.44次、類固醇脈衝治療89人次（2.78%）、環磷醯胺治療97人次（3.02%）、血漿置換12人次（0.37%），170人次（5.30%）曾接受至少1種急性發作治療。結論：高達38.14%懷孕前曾住院或急診就醫，病情不穩定之象徵，高風險群不適合懷孕，容易造成病情不穩定與不良妊娠結果，醫療團隊應告知患者懷孕的風險，並加強計畫性懷孕衛教，讓患者做好懷孕規劃與避孕措施。 Objective: The objective of this paper is to evaluate medical utilizations before pregnancy in systemic lupus erythematosus (SLE) patients. Method: Through a retrospective population-based study (NHIRD), we used ICD-9: 710.0, ≧ 2 times prenatal care, 20~40 age, outpatient, emergency, hospitalization and flare up treatment record of 180 days before the first prenatal care. Result: The average age of 30.4 years (n=3,207), outpatient 21.35 times, emergency 0.53 times, hospitalized 0.44 times, Methylprednisolone pulse therapy 89 patients (2.78%), Cyclophosphamide treatment of 97 patients (3.02%), plasmapheresis 12 patients (0.37%), 170(5.30%) had ≧ 1 flare up treatment. Conclusion: A high incidence of hospitalized or emergency medical treatment before pregnancy in SLE women, easily lead to unstable conditions and adverse pregnancy outcomes. Guiding the risk of pregnancy and planned pregnancy is very important. To enable patients to make pregnancy planning and contraception.

Objective: The objective of this paper is to evaluate medical utilizations before pregnancy in systemic lupus erythematosus (SLE) patients. Method: Through a retrospective population-based study (NHIRD), we used ICD-9: 710.0, ≧ 2 times prenatal care, 20~40 age, outpatient, emergency, hospitalization and flare up treatment record of 180 days before the first prenatal care. Result: The average age of 30.4 years (n=3,207), outpatient 21.35 times, emergency 0.53 times, hospitalized 0.44 times, Methylprednisolone pulse therapy 89 patients (2.78%), Cyclophosphamide treatment of 97 patients (3.02%), plasmapheresis 12 patients (0.37%), 170(5.30%) had ≧ 1 flare up treatment. Conclusion: A high incidence of hospitalized or emergency medical treatment before pregnancy in SLE women, easily lead to unstable conditions and adverse pregnancy outcomes. Guiding the risk of pregnancy and planned pregnancy is very important. To enable patients to make pregnancy planning and contraception.