輕度頭部創傷–腦震盪後症狀與臨床預後狀態的分析與探討

Mild Traumatic Brain Injury – An Exploration of the Post-Concussion Symptoms and Clinical Outcomes

楊啟正(Chi-Cheng Yang)

指導教授 ： 花茂棽

國立臺灣大學/理學院/心理學研究所/博士(2008年)

https://doi.org/10.6342/NTU.2008.00693

摘要

背景：頭部創傷易損害患者的社會職業功能，即使是嚴重程度較輕者亦然。然而，過去研究尚未釐清輕度頭部創傷後的「腦震盪後症候群」如何影響患者的功能性預後狀態。
方法：本論文共分為兩部分。第一部分藉由三篇序列性研究釐清腦震盪後症候群對預後狀態的影響。其中，研究一彌補過去文獻中缺乏腦震盪後症候群造成預後狀態不佳的研究資料，分析該症候群對於預後狀態所產生的負面影響。研究二則試圖改善前篇論文於研究方法上的限制，以「生活品質」做為功能性預後狀態的測量指標，再探腦震盪後症候群對於預後狀態的影響。最後，研究三進一步分析特定腦震盪後症狀，例如：易怒、記憶力缺損等，對於功能性預後狀態的影響。有鑑於第一部分對腦震盪後症狀造成預後狀態的負面影響已有所解析，第二部分則欲找出受持續性症狀困擾的患者，受傷後初期的臨床特徵。
結果與討論：頭部創傷後的神經行為異常顯而易見，而輕度頭部創傷所造成的腦震盪後症候群亦會使患者的功能性預後狀態明顯惡化。再者，該症候群中的身體症狀，例如：頭暈，雖對於患者的預後狀態，以及各個層面的生活品質皆產生妨礙；但心理症狀，例如：易怒或執行功能障礙，較易惡化患者長期性的預後狀態。除了探討輕度頭部創傷患者的預後狀態之外，臨床工作者更需早期偵測出患有持續性腦震盪後震後群的病人。另一方面，亦須建立創傷後神經行為異常的概念模式，瞭解該異常的成因，以做更進一步的預防與處置。

關鍵字

輕度頭部創傷 ； 腦震盪後症狀 ； 預後狀態

並列摘要

Background: Traumatic brain injury (TBI) is detrimental to patients’ social and occupational functions. Persistent post-concussion symptoms (PPCS) following mild TBI can also cause significant psychosocial problems, including stress in family relationships and difficulties in returning to work. However, previous studies that investigated the association between PPCS and functional outcomes were still limited.
Methods: This dissertation is a composite of two major sections with four original studies. The first three studies systematically investigated the association between post-concussion symptoms (PCS) and clinical outcomes. The first prospective study explored the negative impact of PCS on clinical outcomes, while the second one tried to improve the methodological limitations of the previous investigation, and examined the relationship between PCS and patients’ quality of life. Accordingly, the third study further evaluated whether some psychological PPCS, such as irritability and memory deficits, adversely influenced the patients’ functional outcomes. On the other hand, the early clinical features of patients with PPCS have still been unclear. Hence, our last prospective study tried to identify the acute clinical characteristics of patients with PPCS.
Results and Conclusions: The neurobehavioral dysfunctions following TBI were not uncommon. The PPCS following mild TBI could also compromise patients’ functional outcomes. Both the physical symptoms, such as dizziness, and the psychological ones, such as irritability and memory deficits, could be harmful to patients’ long-term clinical outcomes. Thus, the clinicians needed to identify the patients who suffered from PPCS as early as possible, and further explore a neuropsychological model to illustrate the cognitive and emotional disturbances after mild head traumas.

並列關鍵字

Mild traumatic brain injury ； Post-concussion symptoms ； Clinical outcomes

參考文獻

Chen, H.Y., Hua, M.S., Zhu, J., & Chen, Y.H. (2008). Selection of factor-based WAIS-Ⅲ tetrads in the Taiwan standardization sample: A guide to clinical practice. Chinese Journal of Psychology, accepted.

Chi, H.T., & Chiu, W.T. (2005). The classification and medical resources utilization of mild head injury in Taipei city. Taipei: Taipei Medical University, Institute of Injury Prevention and Control.

花茂棽、朱怡娟（2004）。額葉行為量表–台灣版本。台北市：台灣大學心理學研究所。

楊啟正、彭鍾伃、花茂棽（2008）。台大易怒量表。台北市：台灣大學心理學研究所。

Alderman, N. (2003). Contemporary approaches to the management of irritability and aggression following traumatic brain injury. In W.H., Williams, & J.J. Evans (Eds), Biopsychosocial approaches in neurorehabilitation. Assessment and management of neuropsychiatric mood and behavioural disorders (pp. 211-240). Hove UK: Psychology Press.