脊髓損傷患者長期併發症之回溯性研究

Retrospective Study of Long-Term Medical Complications in Spinal Cord Injured Patients

游慧雯(Hui-Wen Yu) ； 蔡素如(Su-Ju Tsai) ； 曾繁斐(Fan-Fei Tseng) ； 黃玉慧(Yu-Hui Huang) ； 施盈如(Ying-Ju Shih) ； 畢柳鶯(Liu-Ing Bih)

《台灣復健醫學雜誌》 34卷3期 (2006/09) Pp. 167-174

https://doi.org/10.6315/2006.34(3)05

摘要

本研究的目的是藉由回顧病歷記載，針對慢性期脊髓損傷的患者，探討其長期併發症發生的情形與分佈、門診就診與用藥、住院與接受手術的概況。總計有52位患者納入研究，自發病至研究期間平均追蹤14.1年。自患者脊髓損傷2年後至研究介入時，有82.7%的患者曾經歷過至少一次便秘的困擾而須就診或用藥，佔所有併發症的第一位。其它好發的併發症依序為：神經性膀胱功能失常、泌尿道感染、肌肉骨骼疼痛、張力過強與腸胃不適。自研究介入回溯一年，發現患者就診原因仍以便秘為最多，佔46.2%，其他常見就診原因依序為：張力過強、神經性膀胱功能失常、肌肉骨骼疼痛、泌尿道感染等等。慢性期脊髓損傷患者重複住院的原因，則以接受泌尿系統追蹤檢查或治療最常見。而泌尿系統的併發症同時也是患者接受手術最常見的原因。42位接受手術的患者中，共有24位患者分別因結石、水腎、腎功能缺損、排尿功能異常等原因接受手術。大部分的併發症可藉由衛教或非藥物治療處理，但便秘、張力、神經性膀胱功能失常、神經性疼痛及腸胃不適，則常須合併藥物治療。
本研究顯示脊髓損傷的患者即使在發病多年後，其長期併發症的發生率仍相當高，且對身體的影響是全面性的。故我們對於慢性期脊髓損傷併發症，應加強患者衛教及規則追蹤，以期提供更好的預防與醫療照顧。

關鍵字

脊髓損傷 ； 併發症 ； 長期追蹤

並列摘要

In order to determine the prevalence of medical complications after spinal cord injury, 52 patients who received regular follow up in a rehabilitation hospital (average 14.1 years) were studied. Medical records were reviewed and analyzed, including demographic data, onset duration, neurological level, locomotion, reason for visiting doctor's office, rehospitalization, medication usage, and surgical intervention. The most common complication encountered was constipation (82.7%). Other common complications were neurogenic bladder dysfunction (80.8%), urinary tract infection (75.0%), musculoskeletal pain (71.2%), spasticity (67.3%) and gastrointestinal disturbance (51.9%). Reviewing the medical records in the most recent year, constipation was still the most common complication (46.2%). Spasticity (40.4%), neurogenic bladder dysfunction (34.6%), musculoskeletal pain (23.1%) and urinary tract infection (21.2%) remained among the top complications. The most common causes of rehospitalization were: regular follow-up of urological system, further rehabilitation training, urinary tract infection, and renal/bladder stone. The most frequent complications that required medication usage were constipation, spasticity, neurogenic bladder dysfunction, neuropathic pain, urinary tract infection and gastrointestinal disturbance. Complications of urological, musculoskeletal and dermatological systems were the most common causes that required surgical intervention.
These findings suggest that there is still high prevalence of secondary complications after long-term spinal cord injury. Multiple systems were involved and thus negatively affect the quality of life. Therefore, we should emphasize the importance of early patient education and regular systemic follow up to enhance long term care after spinal cord injury.

並列關鍵字

spinal cord injury ； medical complications ； long-term follow-up