針灸對腦中風療效評估之實證研究及文獻回顧

林昭庚
中國醫藥大學
腦中風是全球主要死因之一，在美國、日本及台灣為第三大死因。2008年台灣有10,663人死於腦中風，死亡率為46.4/100,000。腦中風有很高的復發率，五年內為35.3％，十年內為51.3%，是「成人殘障」的主要致因。此外，腦中風更是造成老年人失能與失智的主要原因之一，腦中風除了帶給病患身體上的痛苦及心理上的不安，腦中風後的醫療照護花費亦是家庭與社會的沉重負擔。為加強中風病人中醫醫療照護，2010年起腦血管疾病病患之中醫門診及西醫住院中醫會診之特別照護計畫全面納入全民健保給付範圍。中醫運用針灸已經超過2500年的歷史，並且廣泛應用於中風的治療。現今中醫政策或醫療體系之推行，實證數據之有效與否便成為關鍵。因此，若可以過去針灸治療腦中風療效評估作成一份綜合評估的文獻回顧研究，將有助於中醫針灸實證醫學的發展。
本研究利用全民健康保險研究資料庫，探討：（1）台灣中風病人中醫醫療利用及其相關因子，（2）以二次中風等指標評估針灸治療腦中風療效評估並探討其影響因子。本研究也同時針對針灸治療腦中風實證醫學文獻進行評讀。
雖然針灸對中風治療的效果已有很多研究結果，但目前很少有研究探討針灸對於二次中風的預防效果。本研究探討台灣腦中風病人中醫醫療利用情形及其相關因子、針灸治療腦中風之療效評估並探討其影響因子，完整建立針灸治療腦中風實證醫學文獻評讀，研究成果將可提供衛生主管機關訂定中醫藥衛生政策及醫療費用協商之參考，進一步促進針灸實證醫學發展及提昇中醫醫療與照護品質。
關鍵字：針灸、腦中風、療效評估、實證醫學

The evaluation of medical effects of acupuncture on stroke and integrated literature review

Lin Jaung-Geng
Stroke is one of leading causes of deaths worldwide, the third in Taiwan, Japan, and United States. The mortality of stroke was as high as 46.4 per 100,000, with 10,663 persons died from stroke in Taiwan in 2008. Because the recurrence rate of stroke within 5 years and 10 years are 35.3% and 51.3%, respectively, stroke is considered as the most important cause of adult disabilities. It is also one of important causes of elderly dementia and disability leading to the in body pain and mental uneasiness. Besides, the stroke-related medical expenditure is a burden to the family and the society. For enhancing the medical care of Traditional Chinese Medicine (TCM), the TCM-related ambulatory care and the TCM special care integrating with the Western medicine-related hospitalization will be implemented in 2010. Acupuncture has been practiced in TCM care for more than 2500 years and widely used for the treatment of stroke. The evidence-based data and statistics of effectiveness are the crucial indicators for the execution of TCM policy and medical system. As a result, we need to evaluate the effectiveness of acupuncture on stroke treatment and to conduct a comprehensive literature review for estalishing will be helpful in the evidence-based medicine of TCM acupuncture.
This study will use the National Health Insurance database 1) to investigate factors associated with TCM use among stroke patients and 2) to evaluate the effects of acupuncture treatment on the prevention of stroke recurrence and associated comorbidities. Besides, we will review related literature and evaluate effects of acupuncture treatment on the prevention of stroke.
Many studies have investigated the effectiveness of acupuncture on stroke treatment. But little is known about the effects of acupuncture treatment on the prevention of stroke recurrence. This study will provide evidences associated with TCM use among stroke patients and demonstrate the effects of acupuncture treatment on the prevention of stroke recurrence. We expact that findings from the national health insurance data will consist with the comprehensive literature review of the acupuncture treatment on the prevention of stroke. The results of this study can be considered as good references for health authorities in health policies descisions and the negotiation of medical payment. Furthermore, this study may promote the development of evidence-based medicine of acupuncture and the quality of TCM health care.
關鍵字：acupuncture, stroke, Evidence-based medicine (EBM).