非類固醇類止痛藥(nonsteroidal anti-inflammatory drugs, NSAIDs)是全世界最廣泛使用的藥物之一，由於其優異的止痛、抗發炎及解熱作用，故在醫療上運用極廣，老年人經常使用它，來治療骨關節疾患。
非類固醇類止痛藥雖有優異效果，但其消化道副作用卻常發生，從胃痛到出血、穿孔等併發症又衍生另外的醫療問題。本研究在探討使用非類固醇類止痛藥相關消化性潰瘍住院患者其醫療資源耗用情形，並與非使用非類固醇類止痛藥相關之消化性潰瘍比較其資源耗用是否有差異。
本研究使用以台灣某區域教學醫院的次級資料庫為主，收集2008 年1 月1 日至2008 年12 月31 日的病患資料，符合相關潰瘍ICD-9CM 診斷患者為研究對象，瞭解因使用非類固醇止痛藥(NSAIDs)相關潰瘍住院病人之相關醫療資源耗用情形、 比較使用NSAIDs 相關潰瘍住院其使用藥物適應症、 探討服用藥物時間距因潰瘍而住院期間是否有差異。
研究結果顯示：使用NSAIDs 相關潰瘍住院，其患者年齡及共病數與非使用NSAIDs 相關潰瘍住院患者，有統計上顯著差異。兩組病患其幽門曲狀桿菌測試陽性率雖統計上有差異但因其接受測試樣本比例偏低，有低估情形；其醫療資源耗用包括加護病房及一般病房費用、輸血費用麻醉費用、手術費用、檢驗費用、藥物藥事費、醫師診察費、電腦斷層檢查費、超音波檢查費、總住院費並無統計上顯著差異；住院相關檢查如超音波檢查、電腦斷層檢查、手術、內視鏡止血、住院天數、住加護病房、輸血、症狀表現有在有無使用NSAIDs 相關潰瘍並無統計上顯著差異。
使用 NSAIDs 距潰瘍住院日時間，以使用30 日內者在本研究佔最大比例；在使用NSAIDs 之適應症，因使用NSAIDs 相關潰瘍的住院患者中，則以因退化性關節炎及類風溼性關節炎之比例最高。
對於老年族群使用 NSAIDs 患者造成潰瘍而住院，額外花費全民健保平均每人次住院36,490.8 元，對於老年人又需使用NSAIDs 治療骨關節炎疾患這一類患者，健保政策似乎應考慮直接給予預防性使用質子幫浦阻斷劑(proton pump inhibitors) 這一類藥物，此類藥物被證實可以減少使用NSAIDs 造成胃腸道潰瘍。

Nonsteroidal anti-inflammatory drugs (NSAIDs) are one of the most frequently prescribed classes of drugs worldwide. Due to their excellent effects for
analgesic, anti-inflammatory and antipyretic, most elder population used frequently for osteoarthritis.
Gastrointestinal symptoms and ulceration associated with NSAIDs are common.
Such ulcers may cause pain, bleeding, or perforation. It leads to other medical problems. The aim of this study was to examine the utilizations of medical resources associated with inpatients with NSAID related peptic ulcer disease and compared to
non-NSAID related peptic ulcer disease.
The study used the database from a teaching hospital in southern Taiwan.
Inpatients who were identified ICD-9 CM codes as peptic ulcer diseases from January 1st of 2008 to December 31 of 2008 were included in this study. We also examined the indications for usage of NSAIDs, the date of prescription before the index date.
The results showed 17.6% of inpatients with peptic ulcer disease related to NSAIDs. Inpatients with NSAIDs related peptic ulcer disease compared with
inpatients with non-NSAIDs related peptic ulcer disease had significant difference in age and comorbidity. Although rapid urease test positive rate for Helicobacter pylori was higher in group of non-NSAID related peptic ulcer disease, it seemed
underestimate because of the test number of patients was low. The average total direct medical cost of inpatients with NSAID related peptic ulcer was NT$ 36,491 and non-NSAID related peptic ulcer was NT$ 37,266.1. There were no significant difference in medical costs of standard care , intensive care , blood products,endoscopy, endoscopic hemostasis, surgery, CT scan , ultrasound, laboratory tests,medications, doctor’s service between the two groups. Diagnostic and therapeutic procedures were no statistically significant difference, including blood transfusion,CT scan, endoscopic hemostasis, surgery, symptoms presentations, and intensive care.
In this study, the duration for using NSAID was within 30 days for inpatients associated with NSAID related peptic ulcer, which had a substantial excess numbers of ulcer hospitalization. Since the common disease for using NSAID is osteoarthritis,which is very popular in elderly, therefore, we suggested that the policy makers of the National Health Insurance should be aware that preventive usage of proton pump inhibitors for the elder population who need frequent use of NSAIDs might decrease NSAID related ulcer complications.

目錄
中文摘要……………………………………………………………….. I
Abstract……………………………………………………………… III
目錄……………………………………………………………………..V
表目錄……………………………………………………………….. VII
圖目錄……………………………………………………………… VIII
第一章緒論…………………………………………………………… 1
第一節研究背景與動機................................................................. 1
第二節研究目的............................................................................... 2
第二章文獻探討……………………………………………………… 4
第一節非類固醇止痛藥(NSAID)的藥理作用……………………… 4
第二節非類固醇止痛藥（NSAIDs）的副作用……………………. 6
第三節 NSAID 與潰瘍的發生………………………………………. .9
第四節非類固醇止痛藥（NSAID）造成潰瘍之醫療耗用……… 10
第三章研究方法…………………………………………………… 11
第一節 研究架構………………………………………………… 11
第二節 研究設計…………………………………………………… 12
第三節 研究變項…………………………………………………… 14
第四節 統計分析…………………………………………………… 17
VII
第四章研究結果…………………………………………………… 18
第一節研究對象之基本資料分析………………………………… 18
第二節住院期間及相關治療、檢查……………………………… 22
第三節使用 NSAIDs 之適應症及距潰瘍住院日時間…………… 27
第四節獨立樣本 t 檢定的結果…………………………………… 28
第五節卡方檢定的結果…………………………………………… 29
第五章結論與建議………………………………………………… 31
第一節 討論………………………………………………………… 31
第二節結論………………………………………………………… 35
第三節研究限制…………………………………………………… 36
參考文獻………………………………………………………………..42
表目錄
表3-1 NSAID 類藥品………………………………………………… 16
表4-1 病患特質與共病狀況 ……………………………………… 21
表4-2 處置與治療方式……………………………………………… 25
表4-3 使用NSAIDs 及非使用NSAIDs 相關潰瘍住院患者的醫療
費用………………………………………………………… 26
表4-4 患者使用NSAIDs 的適應症 ……………………………… 27
表4-5 NSAIDs 使用距住院日時間 ………………………………… 28
附表一 使用藥品NSAIDs 及併用藥品種類分布…………………… 38
附表二 本研究使用ICD-9-CM 中英文診斷………………………… 39
圖目錄
圖3-1 本研究架構…………………………………………………… 11

參考文獻
Jay L Goldstein.(2004) Challenges in Managing NSAID-associated
Gastrointestinal Tract Injury. Digestion. 69(suppl); 25-33.
U.S. ankarca .(2005) Gastrointestinal Effects of Selective and
Non-selective non-steroidal Anti-inflammatory drugs. Current
Pharmacetuial Design,11, 1779-1793.
Luis Alberto ,Garcia Rodriquez , et al.(2004), Risk of uncomplicated peptic
ulcer among users of Aspirin and Nonaspirin Nonsteroidal
anti-inflammatory drugs. American Journal of Epidemiology,
159;23-31
Frank L Lanza.(1998). A guideline for treatment and prevention of
NSAID-induced ulcers, the American Journal of Gastroenterology.
Vol 93,11, 2037-2045
Marie R, Griffin, Wayne.A. , Ray, William.( 1988). Non-Steroidal
Anti-inflammatory drugs use and death from peptic ulcer in elderly
persons. Ann Intern Med. 109, 359-363.
Jerry Tenenbaum.(1999) , the epidemiology of Nonsteroidal
anti-inflammatory drugs. Canadian gastroenterology.vol.13.2.
Hawkey.(1996). Non-steroidal anti-inflammatory drug gastropathy: cause
43
and treatment. Scand J Gastroenetrol Suppl. 220:124-7
Walter E.Smalley.(1995). Nonsteroidal Anti-inflammatory drugs and the
incidence of Hospitalizations for peptic ulcer disease in elderly
persons . American Journal of epidemiology,Vol. 141, No. 6, 539-545
A. Adamopoulos.(2003). Acute upper gastrointestinal bleeding: c
omparison between recent users and nonusers of nonsteroidal
anti-inflammatory Drugs. Endoscopy.35(4):327-332.
Nigel L.(2005) Risk of hospitalization with peptic ulcer disease or
gastrointestinal hemorrhage associated with Nabumetone, Arthrotec,
Diclofenac, and Naproxen in a population based cohort study. The
Journal of Rheumatology. 32;2212-7.
Fries JF, Miller SR, Spitz PW, et al(1989). toward an epidemiology of
gastropathy associated with nonsteroidal antiinflammatoory drug use.
Gastroenterol.96:647-55.
Armstrong CP, Blower AL.(1987). non-steroidal anti-inflammatory drugs
and life threatening complications of peptic ulceration. Gut.
28:527-32.
Soll AH, Weinstein WM, Kurata J, et al.(1991). non-steriodal
anti-inflammatory drugs and peptic ulcer disease . Ann Intern Med.
44
114:307-19
McCarthy DM.(1989) Nonsteroidal anti-inflammatory drugs-induced
ulcers : management by traditional therapies . Gastroenterol.
96:662-74
Loeb DS, Talley NJ, Ahlquist DA, et al.(1992). Long-term nonsteroidal
anti-inflammatory drug use and gastroduodenal injury: the role of
helicobacter pylori . Gastroenterol. 102;1889-905.
Graham DY, Lidsky MD, Cox AM, et al. (1991)long-term nonsteroidal
anti-inflammatory drug use and helicobacter pylori infection.
Gastroenterol.100:1653-7.
Gabriel SE, Jaakkimainen L, Bombardier C.(1991) Risks for serious
gastrointestinal complications related to the use of non-seroid
anti-inflammatory drugs: a meta-analysis. Ann intern
Med.115:787-96.
Garcia RLA, et al.( 1998).Risk of hospitalization for upper gastrointestinal
tract bleeding associated ketorolac, other nonsteroidal
anti-inflammatory drugs , calcium antagonists and other
antihypertensive drugs. Arch Intern Med. 158:33-9.
Wolfe MM, Lichtenstein DR, et al.( 1999)Gastrointestinal toxicity of
45
non-steroidal anti-inflammatory drugs. N Engl J Med. 340:1888-99.
Harald EV, Rogier MK, et al.(2007). Direct medical costs of serious
gastrointestinal ulcers among users of NSAIDs. Drugs
aging.24:681-690.
Herings RM, Klungel OH.(2001). An epidemiological approach to assess
the economic burden of NSIAD- induced gastrointestinal events in the
Netherlands. 19(6):655-65.
Rahme E, joseph L.(2000). Gastrointestinal health care resource use and
costs associated with nonsteroidal anti-inflammatory drugs versus
acetaminophen: retrospective cohort study of an elderly population.
Arthritis Rheum. 43(4): 917-24.
Bombardier C, Laine L, et al.(2000). Comparison of upper gastrointestinal
toxicity of rofecoxib and naproxen in patients with rheumatoid
arthritis. VIGOR study group. N Engl J Med . 343:1520-8.
Silverstein FE,Faich G, et al. (2000). Gastrointestinal toxicity with
celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis
and rheumatoid arthritis: the CLASS study: a randomized controlled
trial. Celecoxib long-term arthritis safty study. JAMA; 284:1247-55.
Singh G, Triadafilopoulos G. (1999) Epidemiology of NSAID induced
46
gastrointestinal complications . J Rheumatol , 26;15: 18-24
Griffin MR, Piper JM et al. (1991) Nonsteroidal anti-inflammatory drugs
use and increased risk for peptic ulcer disease in elderly persons . Ann
Intern Med 114: 257-63
Ekstrom P, Carling L, et al. (1996) Prevention of peptic ulcer and dyspeptic
symptoms with omeprozale in patients receiving continuous
nonsteroidal anti-inflammatory drug therapy:a Nordic multicentre
study. Scand J Gastroenetrol 31: 753-8
James E. et.al(2006). Aspirin to prevent heart attack and stroke: what’s the
right dose? The American journal of medicine, 119, 198-202
Feldman, Friedman, et al.(2002) Sleisenger and Fordtran’s Gastrointestinal
and liver disease. Pathophysiology/diagnosis/management, 7th edition.
Laurence, et al.(2006). Goodman &Gillman’s the pharmacological basis of
therapeutics 11th edition.
劉人瑋(2006)，彩色圖說藥理學，5th edition.
林肇堂(1996)，幽門曲狀桿菌與胃癌關係的研究，Chin Med J; 57: S120
郭武憲(2002)，全國消化性潰瘍出血住院病患之醫療資源耗用情形探
討，中國醫藥學院碩士論文。
吳登強(2006)，消化性潰瘍病人幽門螺旋桿菌根除與否醫療耗用比較分
47
析，高雄醫學大學碩士論文。
http://www.companiesandmarkets.com