頭部外傷併顱內出血後罹患失智症之趨勢
與醫療資源耗用情形

研究目的外傷性顱內出血的病人約有30%的預後為死亡或失能狀態，是頭部外傷中嚴重度及殘障率最高的一種傷害。許多研究指出，頭部外傷是造成失智症的危險因子之一，倘若頭部外傷併顱內出血病人為失智症的高危險群，將會帶給家庭、社會龐大的經濟負擔。本研究目的為探討頭部外傷併顱內出血罹患失智症之發生率及長期趨勢分析，及頭部外傷併顱內出血病人罹患失智症之相關性，進一步了解頭部外傷併顱內出血罹患失智症病人醫療資源耗用、存活情形之相關影響因素。研究方法本研究為回溯性次級資料的縱貫研究分析(Retrospective longitudinal study)，資料來源為「全民健康保險研究資料庫」，選取1997年至2008年發生頭部外傷併顱內出血病人，國際疾病分類第九版診斷頭部外傷併顱內出血代碼(ICD-9-CM為800.2、800.3、800.7、800.8、801.2、801.3、801.7、801.8、803.2、803.3、803.7、803.8、804.2、804.3、804.7、804.8、852、853)，並排除頭部外傷時已有失智症（ICD-9-CM 290、294.1、331.0）及發生頭部外傷併顱內出血後六個月內死亡之個案進行分析。研究結果 12年總樣本數6,478人中分析發現，頭部外傷併顱內出血的發生率有逐年增加的趨勢，但頭部外傷併顱內出血後罹患失智症的發生率呈現逐年下降的趨勢。頭部外傷併顱內出血病人與罹患失智症有顯著關係的變項：65歲以上、45-64歲及25-44歲相對於24歲以下頭部外傷併顱內出血病人罹患失智症的機會各為30.74倍(P<0.001)、11.77倍(P<0.001)、4.05倍(P<0.001)，年齡層越高罹患失智症機會越高；有接受開顱手術者罹患失智症的機會是沒有開顱手術的1.37倍(P=0.005)。頭部外傷顱內出血種類為SDH的病人，死亡率為非SDH病人的1.75倍(P=0.008)。結論與建議透過本研究發現頭部外傷併顱內出血病人發生率有增加的趨勢，失智症的發生與此類病人有相關性。因此高齡、接收開顱手術的頭部外傷併顱內出血病人，除了失能的復健外，應及早偵測失智症的症狀或提供預防措施以降低罹患率，減少醫療社會資源的耗用。

關鍵字

頭部外傷併顱內出血；失智症；發生率；醫療資源耗用；死亡情形

並列摘要

Backgrounds and Aims Intracranial hemorrhage (ICH) in head trauma patients has a high mortality and/or functional disability rate of 30%; it is the most severe form of head injury and causes the highest rate of disablement in head trauma patients. Numerous studies have identified head trauma as a risk factor for dementia in survivors. If the elevated risk of dementia is confirmed in survivors of head injuries with ICH, an additional economic burden will be placed on affected families and society in general. This study aims to investigate the incidences of dementia, including a longitudinal analysis, in survivors of head injuries with ICH, as well as causality between head trauma patients with ICH and the onset of their dementia. Thus filling in a current knowledge gap in the quality of life, survival prospect and the clinical management costs for survivors of head trauma with ICH who subsequently developed dementia. Methodology This is a retrospective longitudinal study of existing data from the "National Health Insurance Research Database". The research cohort extracted includes head trauma patients with ICH selected from 1997 to 2008. Inclusion criteria were in accordance with the International Classification of Diseases Ninth Edition, utilizing diagnosis of head trauma and intracranial hemorrhage codes (ICD-9-CM is 800.2, 800.3, 800.7, 800.8, 801.2, 801.3, 801.7, 801.8, 803.2, 803.3, 803.7, 803.8, 804.2, 804.3, 804.7, 804.8, 852, 853). Exclusion criteria are: patients with a pre-existing dementia diagnosis (ICD-9-CM 290,294.1,331.0) at the time of injury and cases where death occurred within six months after injury. Results A total of 6,478 cases over 12 years were analysed and revealed an annual increasing trend for incidences of head trauma with ICH, however, dementia in the same cohort showed a decreasing trend. Incidences of dementia in head trauma patients with ICH showed an age-stratified trend: incidences of dementia in over 65 years, 45-64 years and 25-44 years when compared to <24 years are, respectively, 30.74-fold (P <0.001), 11.77-fold (P <0.001), 4.05-fold (P <0.001). Whereby a higher age-stratosphere equates to a higher incidence of dementia post-injury. The incidences of dementia in patients who had received craniotomy is 1.37-fold higher (P = 0.005) when compared to a non-surgical group. In addition, head trauma patients with intracranial hemorrhage subtype - Subdural Hematoma (SDH) - has a 1.75-fold (P = 0.008) higher mortality rate when compared to the non-SDH patients. Conclusion The study found that the incidences of head trauma with ICH is increasing, and correlates with an increase in the post-injury incidences of dementia in the same cohort. Therefore, it is imperative that older head trauma patients with ICH who is also receiving a craniotomy be tested for symptoms of dementia, or be provided with preventative measures to reduce morbidity. The additional health management protocol should be included as part of their rehabilitation regime. Taken together, these recommendations aims to reduce the unnecessary burden on public health resources.

並列關鍵字

head injury with intracranial haemorrhage ； dementia ； incidence ； medical resources consumption ； mortality

參考文獻

Charlson, M. E., Pompei, P., Ales, K. L., & MacKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases, 40(5), 373-383.

王雅玲、黃崇謙、楊啟賢（2006）．頭部外傷原因與醫療資源耗用．北市醫學雜誌，3(11)，53-64。