交通意外事故造成患者嚴重腹部鈍傷及臟器出血之流行病學分析

The Epidemiological Analysis of Severe Blunt Abdominal Trauma Patients with Visceral Organ Bleeding or Injury Due to Traffic Accidents

葉兆斌(Chao-Bin Yeh) ； 林錦源(Jin-Yuan Lin) ； 吳舜如(Shun-Ju Wu) ； 陳智豪(Chih-Hao Chen)

《重症醫學雜誌》 8卷4期 (2007/12) Pp. 156-165

https://doi.org/10.30035/TCCM.200712.0002

摘要

背景：腹部鈍傷是常見的致死因素之一，所有年齡層患者均可能發生，尤其是青少年族群。在生命徵象不穩定的狀態下，嚴重腹部鈍傷患者絕大多數需經過電腦斷層檢查才能確認其內出血部位，然而在初期的診斷過程中，尚具有潛在的致死風險。因此，評估電腦斷層檢查的必要性、先後次序及確定治療方向，將成爲創傷科醫師的一大挑戰。
目的：急診意外事故患者因嚴重腹部鈍傷產生內出血問題的流行病學探討。
方法：本研究於2005年1月至12月期間，以中部某醫學中心急診部的交通意外事故患者，並造成內出血症狀的嚴重腹部鈍傷(ISS≧9)患者爲研究對象，進行人口學資料、事故原因、出血位置及其外傷嚴重度等方面的統計分析。
結果：本研究之有效樣本數爲14人，男性居多，有9人(64.3%)，平均年齡爲31.4±13.6歲，外傷嚴重度分數平均值爲29.6±21.3分。在就診型態方面，居多者為12-18時就診者5人(35.7%)，機車意外事故者10人(71.4%)，本身爲駕駛者10人(71.4%)，經EMT轉送者9人(64.3%)。患者傷勢方面，撞擊傷造成者有8人(57.1%)，摔傷則有6人(42.9%)，2人(14.3%)到院前死亡。臟器損傷方面以肝臟破裂居多，有11人(78.6%)，脾臟破裂次之，有4人(28.6%)；急診處理後直接開刀者3人(21.4%)、住院觀察及治療者10人(71.4%)、於急診死亡者1人(7.1%)。
結論：意外事故是國人的第五大死因，其中交通意外是最主要的原因，常造成患者死亡或殘障。創傷科醫師在處理意外事故造成的腹部鈍傷患者時，應注意患者內出血的可能型態，給予適當而即時的診斷檢查來排除內出血的疑慮，使患者能夠獲得妥善的緊急醫療，並提高其存活率。

關鍵字

腹部鈍傷 ； 意外事故 ； 臟器出血 ； 外傷嚴重度分數

並列摘要

Background: Blunt abdominal trauma (BAT) is one of leading fatal cause among all age groups worldwide especially in teenage. Although abdominal CT scanning is the most specificity and current diagnostic tool for BAT, many serious patients may not manifest during the initial assessment in unstable patients. So the timing for CT scanning and identification of serious intra-abdominal pathology is often challenging by physicians due to potential risk of death during evaluating procedure.
Purpose: This study is an epidemiological analysis to explore of the severe blunt abdominal trauma patient with internal bleeding or visceral organ injury due to the road traffic accident.
Methods: This is a prospective study of traffic accidental subjects with an Injury Severity Score (ISS)≧9 points who visited a medical center Hospital in central part of Taiwan from January to December in 2005. Data collected included demographics, gender, injury mechanisms, severities, emergency management and outcome of severe subjects with internal bleeding due to blunt abdominal trauma.
Results: 14 qualified patients in this study. The results of analysis were as following: majority of cases were 9 males (64.3%), mean of age was 31.4±13.6 years, and mean of ISS was 29.6±21.3. The followed were various characteristics of BAT patients: majority was visited at 12-18 o'clock (5 cases, 35.7%), motorcycle accident (10 cases, 71.4%), driver (10 cases, 71.4%), transferring by EMT (9 cases, 64.3%). The mechanisms of injury were 8 traffic collisions (57.1%), 6 tumbles (42.9%) and 2 DOAs (14.3%). The majority locations of internal bleeding were liver lacerations (11 cases, 78.6%) and followed by spleen (4 cases, 28.6%). There was a patient presented a combined injury with brain, chest and pelvic respectively. After making emergency rescue, 3 patients (21.4%) underwent an urgency surgery, while 10 patients (71.4%) were hospitalizations without operative treatment, and 1 patient (7.1%) expired during treatment in emergency department.
Conclusion: Accident is the 5th leading cause of death among all age groups in Taiwan; the road traffic accident is the major one of contingency and causes often deaths or dysfunctions. The trauma physicians must pay attentions to the possible of internal bleeding of accident patients with a blunt abdominal trauma; making a suitable and immediate diagnostic test to exclude the misgiving of internal bleeding, and then to provide a properly emergency medical and surgical care in order to improve survival rate.

並列關鍵字

Blunt abdominal trauma ； Traffic accident ； Visceral organ bleeding ； Injury severity score