失眠是當前社會最需要關注的疾病之一，全世界有1/4 的人受到失眠之苦，而其中只有 20% 得到良好的治療。藥物治療是失眠治療中的一個重要而有效的治療方式，但是安眠藥物在治療失眠的同時，在其他層面上帶來的負面影響相當的大，常常會增加意外受傷的危險以及骨折的危險。本研究希望找出可能影響服用安眠藥之後至急診與骨折住院的因子，希望藉此可提出日後對於失眠治療的醫療經濟與醫療政策的建議。
研究設計為對2001-2007 年的百萬人檔健保資料庫進行分析，將民眾分為兩組，篩選在 2001-2003 年間使用過 Zolpidem, Zolpiclone 與 Flunitrazepam 三種不同的安眠藥的個案為個案組，另外依照性別年齡取三倍人數為對照組，比較個案組與對照組在 2004-2007 三年中發生急診事件與因骨折住院的比率，並回溯有發生骨折事件的個案，觀察在三個月內是否有取安眠藥的紀錄。以便釐清此為長期或是短期藥物的影響。
從資料庫中一共篩選出 55155 位使用過藥物的個案為個案組，165465 人為對照組。個案組至急診就診的次數為 2.14 次，多於對照組的 0.99 次，因骨折住院的機率分別為 13.83% 與 5.05％。經過迴歸分析後，發現影響急診率與骨折住院的因子為年紀、性別、三個月內安眠藥取藥史、取藥的種類與種類數。另外也發現個案組有較高的比例因為睡眠相關的問題而到急診。
本研究的發現指出，年紀與開立安眠藥的種類，數量，相當程度的影響了骨折住院的比例。最危險者為年紀越大的民眾與取藥多種，醫師應該盡量避免開立兩種以上不同的安眠藥，對於老年病人應該非常注意提高骨折的危險。本研究的成果除可作為處方參考，對於安眠藥管制政策，以及後續醫療經濟的探索有所助益。

Insomnia is one of commonest disease in modern age. There is about a quarter of all population suffered insomnia while only one fifth had their sleep disorder treated adequately. Hypnotic is one of the most powerful treatment to insomnia, but it had negative effect as well. Using hypnotics is considered related to the increasing of trauma and fracture. We aimed to figure how prescription of hypnotics affects the rate of ER visit and fracture.
We used National Health Insurance Research Database as our data source. From database we selected people who take any of 3 hypnotic, naming Zolpidem, Zolpiclone and Flunitrazepam, in 2001-2003 as case group. The control group was a 3 times population sampling. The outcomes were rates of ER visit and admission for fracture. We also traced their history in past 3 months to see if any hypnotics were prescribed.
More than 50 thousand people was enrolled in the case group. People of this group utilized more ER visit (2.14 to 0.99) and had more fracture (13.83% to 5.05%). The factors that affect the outcomes are age, gender, and prescription of hypnotics in past 3 months. We also figure out increments of ER visit simply for refill hypnotics in case group.
Since age and prescription of hypnotics increase rates of events, we suggest clinicians take more cautions with prescribing hypnotics for elderly, and avoid of using 2 or more combination of hypnotics. The result of this study can also be helpful to future study of hypnotics control issues and medical economics studies.

第一章 [緒論 1]
第二章 [文獻探討 4]
第三章 [研究方法與材料 13]
第四章 [研究分析與結果 17]
第五章 [研究討論 26]
第六章 [研究結論與建議 30]
[參考文獻 33]

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