創傷性脊髓損傷者一年內之存活

One-year Survival after Traumatic Spinal Cord Injury

李孟如(Meng-Ju Lee)

指導教授 ： 林茂榮

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(2005年)

摘要

目標：追蹤創傷性脊髓損傷者受傷後一年內的存活和主要死亡原因，並探討影響創傷性脊髓損傷者之存活相關因子。 方法:本研究採用病歷調閱方式調查1999年7月1日至2004年6月30日發生創傷性脊髓損傷者資料,共有714位樣本，並以核對衛生署死因資料庫及電話訪談追蹤等方式確認患者存活情形與死亡原因。利用比例式危險模式(proportional hazards model) 探討影響存活的相關危險因子。 結果：樣本中有674位追蹤滿一年。受傷後一年內的存活率為88.3%。受傷後一個月及一年內主要死亡原因皆以非故意傷害比例最高，分別為78%及59.5%。多變項分析，受傷年齡每增加1歲，死亡的風險就提高5%。行人交通事故的危險比較四輪機動車交通事故高3.52倍（危險比＝3.52）。神經損傷嚴重度中感覺與運動功能全無、僅有感覺功能無運動功能、有部分運動功能但主要關鍵肌無法抗重力比有運動功能且主要關鍵肌可抗重力的危險比高17.7、8.68、3.09倍（危險比＝17.7、8.68、3.09）。外傷嚴重度分數每增加1分，死亡的風險就提高7%。 結論：創傷性脊髓損傷者受傷後一年內的存活率為88.3%，主要死亡原因為非故意傷害。另外，受傷年齡越大、行人交通事故、外傷及神經損傷程度越嚴重，皆顯著影響脊髓損傷者一年內的存活。

關鍵字

脊髓損傷 ； 存活 ； 死亡原因

並列摘要

Objective: To examine one-year survival and it is determinants among persons with traumatic spinal cord injury (SCI). Method: To investigate the materials of SCI patients from July 1, 1999 to June 30, 2004 by reviewing medical records of 5 hospitals. In addition to using death registration system of the Department of Health in Taiwan, follow-up phone calls was also conducted to crosscheck the survival and cause of death. The proportional hazards model was used to identify risk factors for the one-year survival. Results: Among 714 eligible patients, 674 were followed up for one year. The survival rate in the first year postinjury was 88.3%. In the first month and first year postinjury, the first leading cause of death was unintentional injuries (78% and 59.5%). The proportional hazards model found that, if age at injury increased 1 year, the risk of death enhances 5%. The hazards ratio of the pedestrian to motor vehicle traffic accident was 3.52 [95% confidence interval (CI) 1.28 to 9.71]. In the neurological class compared to motor function and key muscles grade of 3 or more, the hazards ratio of no motor and sensory function, sensory function, and motor function but key muscles grade less than 3 were 17.7 (95% CI 9.04 to 34.7), 8.68(95% CI 3.82 to 19.8), and 3.09 (95% CI 1.35 to 7.09) respectively. When the injury severity score (ISS) increased 1 point, the risk of death enhances 7%. Conclusion: The survival rate after the first year postinjury among traumatic SCIs and the first leading cause of death was unintentional injuries. Furthermore age at injury, type of injury cause and injury severity significantly influenced the survival of the first year postinjury for patients with traumatic SCI.

並列關鍵字

spinal cord injury ； survival ； cause of death

參考文獻

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