目的： 本研究是要探討精神專科醫院病人使用長效型BZDs 類藥物 (flurazepam) 後導致跌倒的發生率及造成跌倒的可能危險因子。
方法： 我們收集南部某精神專科教學醫院從2013 年4 月至2015 年2 月曾經使用flurazepam 的所有住院個案及跌倒紀錄。為了探討跌倒及跌倒次數相關的危險因子，分別以多變項邏輯迴歸及多變項直線迴歸來執行探討。並利用Spearman’s 相關係數探討跌倒次數與flurazepam 住院總劑量之間的相關性。
結果： 本研究總共收集293 位個案。其中有45 位個案 (15.4%) 有跌倒事件被通報。住院個案發生跌倒及未發生跌倒兩個組別間的flurazepam 住院累積總劑量分別為164.82 ± 180.45 顆及106.96 ± 152.27 顆 (p =0.048)。Flurazepam 住院累積總劑量 (OR = 1.002) 為發生跌倒的危險因子 (p = 0.03)。Flurazepam 住院累積總劑量越多的個案與跌倒次數具有正相關性 (ρ = 0.13, p = 0.02)。而年齡越小、思覺失調症及情感性精神病為跌倒事件的保護因子。80.89% 個案於住院期間曾經共併一個以上的BZDs 藥物或Z 藥物。最常併用的BZDs 藥物為clonazepam (32.65%)。
結論： 我們的研究顯示約有15.4% 病人於住院期間使用flurazepam曾經被通報過跌倒事件。住院期間flurazepam累積使用劑量越多、住院個案年齡越大、入院診斷為酒精性精神病及藥物性精神病的個案比較容易發生跌倒事件。因此，對於使用flurazepam且具有相關危險因子的住院個案，於臨床上我們必須特別關注這類病人以減少跌倒而造成傷害的發生。
Object: The purpose of this study is to investigate the incidence and the risks factors of fall-related injuries among inpatients using flurazepam in the psychiatric hospital.
Methods: We collected the basic information and records related to fall of inpatients ever using flurazepam in a southern psychiatric hospital in Taiwan from April 2013 to February 2015. We used the multiple logistic regression analysis to investigate the risk factors of fall-related injuries and the multiple linear regression analysis to study the factors related to the times of falling. Moreover,Spearman’s rank correlation was used to calculate the correlations between the cumulative doses of flurazepam and the times of falling.
Results: There were 293 patients ever used flurazepam. Forty-five subjects (15.4%) falling down were reported during admissions. The cumulative doses of flurazepam are 164.82 ± 180.45 capsules among subjects experienced fall. The risk factor of falling is the cumulative doses of flurazepam and the preventive factors are younger age, schizophrenic disorders, and affective disorders. In addition, the cumulative doses of flurazepam and the times of falling were significantly correlated (ρ = 0.13, p = 0.02). About 80.89% patients combined at least one BZDs or Z-drugs and the most comorbid medication with flurazepam is clonazepam (32.65%).
Conclusions: In our study, we found 15.4% of patients falling down during admissions. The risk factors of fall-related injuries were elderly, the cumulative doses of flurazepam, alcohol-induced mental disorders, drug-induced mental disorders, and delusional disorders. Thus, in order to decrease the risk of whom using flurazepam resulting in falling down, we should be aware of patients with above risk factors.
