針灸對中風後血管型失智症病人之效果評估：以全國性資料分析為例

Evaluation of the Efficacy of Acupuncture on Vascular Dementia after Stroke in Taiwan: a population-based study

目的：針灸是中醫治療方法之一，過去研究曾指出針灸治療有助於改善病人 的認知功能，但尚無對於血管型失智症（Vascular Dementia, VaD）併發症及醫療 利用的療效分析。本研究目的為探討 VaD 病人接受針灸輔助治療後對日常活動改 善、血管型失智症相關併發症及醫療利用之療效。方法：本研究由衛生福利資料 科學中心之多個資料庫，篩選民國 95-98 年中風後三個月內及中風後五年內發生 VaD 的兩個世代的病人，排除小於 20 歲、中風前有失智症及中風後三個月內死亡 者。透過 Cox 比例風險模型及廣義估計方程式等進行校正，分析接受西藥加針灸 輔助治療對病人六個月內日常活動、一年內血管型失智症相關併發症與醫療利用 之影響。結果：相較於僅接受西藥組的病人，針灸輔助治療組在 VaD 後一年內發 生肺炎（HR=0.69, p< 0.01）及死亡風險（HR=0.34, p< 0.01）較低。兩組病人在日 常活動及一年內各項醫療利用及費用之變化則未達顯著差異。結論：VaD 的病人 接受西藥加針灸輔助治療發生肺炎及死亡風險較低，本研究結果建議針灸可做為 中風後 VaD 病人的治療方式之一。

Objectives: Acupuncture is a treatment technique in Traditional Chinese Medicine. Some studies indicate that acupuncture could improve cognitive function of patients, however, the effectiveness on complication prevention and medical utilization for vascular dementia (VaD) is scarce. This study aims to examine the effect of adjuvant acupuncture therapy for VaD patients on daily activities, VaD related complications and medical utilizations. Methods: This study included two cohorts of VaD patients between 2006 to 2009 from the datasets provided by Health and Welfare Data Science Center: those had VaD within three months (cohort 1) and within 5 years (cohort 2) after the stroke. Patients under 20 years old, had dementia or Alzheimer’s disease before stroke, died in 3 months after stroke were excluded. Effects of adjuvant acupuncture on modified Rankin Scale (mRS), Barthel Index in 6 months, VaD-related complications and medical utilization in 1-year after VaD were analyzed using Cox proportional hazard model and General Estimating Equations (GEE). Results: Compared to the group received western medication only, adjuvant acupuncture therapy group had significantly lower risk of pneumonia (HR=0.69, p< 0.01) and death (HR=0.34, p< 0.01) in 1 year after VaD. But differences of changes of daily activities, medical utilization and expenditure in one year were not significant between these two groups. Conclusions: VaD patients received adjuvant acupuncture therapy had lower risk of pneumonia and mortality. Therefore, adjuvant acupuncture therapy could be considered as one of the alternatives for treating VaD patients.