外傷性腦受傷病患之存活因素分析

Prognostic factors of traumatic brain injury survivors

楊翎玉(Ling-Yu Yang)

指導教授 ： 邱文達

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(2009年)

摘要

目的：根據2007年行政院衛生署統計，事故傷害是臺灣居民的第五位死因。其中，外傷性腦受傷是導致意外傷害死亡之主因。而台灣地區自1997年實施騎機車強制配戴安全帽的政策後，顯著降低了外傷性腦受傷病患的致死率。但許多文獻顯示，外傷性腦受傷會對患者後續存活情形產生負面影響。因此，本篇研究目的為探討影響外傷性腦受傷患者存活的相關預後因子。
方法：本研究對象包括從2003年至2006年期間由「外傷性腦受傷資料庫」所收集的14,277位病患，利用身分証字號連結「行政院衛生署」2003至2007年死因檔資料庫，確認研究個案其死亡時間紀錄。以Kaplan-Meier method分析外傷性腦受傷病患受傷後一年內存活情形並使用比例式危險模式估計各預後因子與存活情形之關係。
結果：結果顯示進入分析的13,637位外傷性腦受傷患者中，有1,249位病患在受傷後一年內死亡，存活率為90.84%，其中有64.6%的病患在受傷後第一個月內死亡。昏迷指數(GCS)、年齡、性別、跌倒、神經障礙、顱骨骨折與顱內出血等預後因子與受傷後一年內死亡的風險分布有關，均達統計上顯著意義。
結論：總結以上，本研究結果發現外傷性腦受傷病患其昏迷指數(GCS)等各項傷害特徵的差異在受傷後一年內的死亡風險中的確扮演了關鍵要素。藉由檢查結果與傷害特徵的分類，選擇適合的個人照護、醫療介入與加強支持，才能有效幫助病患術後的復健及預防受傷後一年內死亡情形的發生。

關鍵字

頭部外傷 ； 外傷性腦受傷 ； 預後因子

並列摘要

Purpose：In 2007, injuries were the fifth leading cause of death in Taiwan. Moreover, the major subtype of injury is Traumatic brain injury (TBI). Although Taiwan's implementation of the mandatory helmet law since 1997 has significantly reduced TBI fatalities, most studies have found that TBI negatively impacts long-term survival. The aim of the study was to identify prognostic factors for survival in patients after TBI.
Method：The data of patients with TBI were extracted from the Head Injury Registry between 2003 and 2006. Using the data as the sampling frame, 14,277 patients and the dataset of death registration for the Department of Health (DOH) between 2003 and 2007 were linked by same ID no. Kaplan-Meier estimates of the cumulative proportion of deaths that occurred within 1 year wer computed for each risk factor. Prognostic factors influencing the survival period were examined by Cox proportional hazard model.
Result：Of the 13,637 eligible patients selected for participation, 1,249 were deceased within 1 year and the survival rate was 90.84%. About 64.4% of the death patients occurred within the first month. Factors including Glasgow coma scale (GCS) score, age, sex, fall, cranial nerve lesion, fracture of skull, and intracranial hemorrhage, may play an important role in predicting the outcome of traumatic brain injury.
Conclusion：In summary，we found that prognostic factors with Traumatic brain injury have a large variability. Glasgow coma scale (GCS) score and injury patterns play an important role in predicting mortality within 1 year in our data. Healthcare providers should give the appropriate personal care、medical intervention to these patients during the postacute care period. Further methods of care must be developed and implemented to minimize the mortality and to maximize the opportunity for full recovery among all patients with TBI.

並列關鍵字

Head injury ； Traumatic brain injury ； Prognostic factors

參考文獻

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