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Hui-Jer Chou1 Shun-Ku Lin1,2,6 An-Lu Chen1 Mei-Ru Chen1
Hsu-Tung Hsieh1 Su-Jhen Wu3 Ying-Xue Wang4 Yao-Chien Tsai1,5*
1Department of Chinese Medicine, Taipei City Hospital, Renai Branch. Department of Health,
Taipei City Government, Taipei, Taiwan
2Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
3Department of Pharmacy, Taipei City Hospital, Renai Branch, Department of Health, Taipei
City Government, Taipei, Taiwan
4Department of Nursing, Taipei City Hospital, Renai Branch, Department of Health, Taipei
City Government, Taipei, Taiwan
5Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
6School of General Education Center, University of Taipei, Taipei, Taiwan
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Background: Dementia is an international health issue in elder people.Gastrostomy tube feeding to address eating problems in patients with dementia introduce risks of respiratory tract infection or esophagus trauma. Traditional Chinese medicine (TCM) is widely used to treat swallowing difficulty in Taiwan.We investigated the long-term clinical effects of TCM for reducing the risk of gastrostomy tube feeding in dementia patients.
Methods: We used National Health Insurance Research Database to conduct a retrospective study of dementia patients with difficult voiding symptoms between 1997 and 2009 in Taiwan. We collected medical data from the onset of dementia to gastrostomy tube insertion. Cox regression proportional hazards model and cumulative incidence of the gastrostomy tube curve were used to determine the association between the risk of swallowing difficulty and TCM use.
Results: Data from 11069 patients with dementia was assessed, and 9438 participants who received medication for relief swallowing difficulty were categorized into 2 groups: 4094 (43.4%) were TCM users and 5344 (56.6%)were TCM non-users with a mean follow-up period of 5.4 years. Cox regression demonstrated that using TCM may decrease the need for gastrostomy tube in patients with dementia (adjusted hazards ratio (aHR)=0.84, 95% confidence interval (95% CI): 0.76-0.92) compared to TCM non-users. A relationship between longer TCM use and reduced urinary retention with gastrostomy tube use was observed, especially in patients who used both herbal and acupuncture treatment (aHR=0.67, 95% CI: 0.58-0.76). Ban-Xia-Hou-Pu-Tong (aHR=0.76, 95% CI:0.64-0.88), Li-zhong Tang (aHR=0.57, 95% CI: 0.35-0.74) were the most two beneficial TCM formulae.
Conclusions: The results of this study suggest that TCM is associated with a reduced risk of gastrostomy tube in patients with dementia, with enhanced benefits from longer durations of TCM use.
Keywords：traditional chinese medicine, dementia, nasogastric tube, acupuncture,
Ban-Xia-Hou-Pu-Tong
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231.2失智患者中醫治療後有較低的接受鼻胃管灌食風險
