輕微頭部外傷病患之流行病學研究分析

Outcome and Epidemiology of Mild Brain Injury Patients

馮卓超(Cho-Chao Feng)

指導教授 ： 邱文達 ； 林茂榮

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2003年)

摘要

中 文 摘 要 頭部外傷是一個很重要的公共衛生問題。每年因頭部受傷導致殘障或死亡的人極多，而頭部外傷中又以輕度頭部外傷（Mild Traumatic Brain Injury, MTBI）的患者佔大多數。本研究主要針對輕度頭部外傷作流行病學分析，收集民國90年7月1日至91年6月30日，台北市22家醫院頭部外傷病患，共計3,256人。由病歷報告中得知病人受傷的原因、顱內出血、痙攣、健忘及預後等情形。結果發現輕度頭部外傷的患者中男性佔大多數（61.9%）。以年齡來看，發生在20-29歲之間最多（23.7%）。受傷原因中車禍是主要的原因（47.1%），而跌落和遭人攻擊分居於第2、3位。跌落情形中，滑倒最多（63.7%）。受傷情形中，顱骨骨折佔8.0%；意識喪失佔19.7%；傷後健忘佔4.1%；傷後有痙攣佔1.8%；顱內出血佔21.1%，有6.2%的輕度頭部外傷患者接受開顱手術。以顱內出血來看，性別、年齡、受傷原因和顱骨骨折是導致輕度頭部外傷產生顱內出血的主要危險因子。造成顱內出血的原因中，遭人攻擊(24.8%)及跌落(52.6%)為其主要的機轉。另外，輕度頭部外傷顱內出血的病歷中，合併顏面骨折是沒有骨折的0.29倍；合併上肢骨折是0.36倍；合併神經障礙是2.49倍；合併有意識喪失是2.13倍；合併有顱骨骨折是2.86倍。輕度頭部受傷6個月後，多數傷者仍持續有頭痛、疲勞乏力、頭暈等主觀症候；傷者在輕度頭部受傷後的日常居家和社交活動有減少的現象。另外以預後而言，所有輕度頭部外傷中，大約有10%的患者會導致死亡或殘障。而以輕度頭部外傷合併顱內出血的病例中，則有約20%會導致死亡或殘障等嚴重後果，因此輕度頭部外傷是不容忽視的。 關鍵詞：輕度頭部外傷、顱內出血

關鍵字

輕度頭部外傷 ； 顱內出血

並列摘要

Abstract Traumatic brain injury (TBI) has always been a concerned issue in the field of Public Health. The numbers of disability and death caused by TBI has a significant influence on society. Majority of the TBI patients were categorized under Mild traumatic brain injury (MTBI). The main purpose of this study is to analyze the epidemiology of MTBI. The present study will confer with the possible risk factors involved. The data includes 3,256 cases collected from 22 hospitals in Taipei City during 2001.7.1 - 2002.6.30. The following subject matters were analyzed from the data collected: The causes of injury; presence of intracranial hematoma or spasm; post-injury amnesia and final outcome. We found that males occupy the majority of the MTBI cases (61.9%). Ages 20-29 yr has the highest incidence rate (23.7%). Traffic accident was the major cause of MTBI (47.1%), followed by falling and assault respectively. Slip and fall occupy the majority of the falling cases (63.7%). In the conditions of injury, skull fracture was found to occupy 8.0%, loss of consciousness 19.7%, post-injury obliviousness 4.1%, seizure 1.8%, intracranial hematoma 21.1%, and 6.2% cases received craniotomy. The main risk factors that caused intracranial hematoma in MTBI cases includes: sex, age, cause of injury, and skull fracture. Assault (24.8%) and falling (52.6%) were the major risk factors for the cause of intracranial hematoma. Also, the occurrence of intracranial hematoma in MTBI with facial bone fracture has 0.29 times more than those without it; the upper limbs fracture is 0.36 times; the neurological deficit is 2.49 times; loss of consciousness is 2.13 times; the skull bone fracture is 2.86 times. Six months after MTBI, most patients still have self-complaints of headache, fatigue, dizziness. Also, a decreased daily home activities and social activities were observed. As final outcome, about 10% of all MTBI cases will results in disability and death. And among those MTBI associated with intracranial hematoma cases, there is approximately 20% cases result death and disability. Therefore, additional consideration should be given to MTBI, especially with significant awareness from health care providers. Keywords: Mild Traumatic Brain Injury, MTBI, Intracranial hematoma

並列關鍵字

MIld traumatic Brian Injury ； MTBI ； Intracranial Hematoma

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