頭部外傷病患急性期認知功能評估對初期預後之預測效力探討

頭部外傷所造成的失能及死亡逐年超過其他疾病，其中認知功能缺損所造成的失能時間遠比生理的障礙更長久。本研究目的在探討頭部外傷患者急性期認知功能狀態對於功能性預後之預測效力。以前瞻性研究設計，採立意取樣方式，自98年8月15 日至99年02月15日期間，於中台灣某區域教學醫院外科病房進行資料收集，以頭部外傷病患為研究對象，獲有效樣本數為77位，其中含輕度頭部外傷者52位，中重度頭部外傷者25位。在入住病房第一天及出院時以訪談及觀察方式進行結構式工具測量記錄，包括：意識狀態Glasgow Coma Scale (GCS)、認知功能程度Rancho Los Amigos levels of cognitive function Scale (RLAS)、失憶及定向感Galveston Orientation and Amnesia Test (GOAT)，並於受傷後三個月以Glasgow Outcome Scale - Extended (GOSE)評估追蹤病患之功能性預後狀態。資料整理後，以SPSS 17.0套裝軟體分輕度及中重度頭部外傷兩組進行分析，描述性統計分析包括次數分配、百分比、平均值、標準差；推論性統計以成對樣本t檢定(paired-samples t test)、簡單回歸(simple regression)以及多元回歸(multiple regression)進行分析。研究結果發現，年齡與預後具有高度相關性；再者，在控制年齡對於預後的影響後，輕度頭部外傷患者於入住病房第一天及出院時，無論再增加GOAT或者RLAS 量表的評估，均可以提升對初期預後狀態的預測效力；而中重度頭部外傷者僅出院時的GCS評估結果具初期預後狀態的預測效力。建議醫療團隊將RLAS與GOAT列入頭部外傷病患急性期之常規評估，以監測認知功能變化；同時讓家屬瞭解病患潛在的認知缺損問題以及初期可能的預後狀態，協助及早進行出院規畫。

關鍵字

頭部外傷；認知功能；功能性預後；預測效力

並列摘要

Traumatic brain injury related morbidity and mortality gradually exceed other diseases in recent years. Among the morbidities, cognitive impairment can lead to a longer disable period than physical impairment. In this study, we investigated whether cognitive function evaluation in the acute phase was predictive of functional outcome. This is a prospective and descriptive study which enrolled 77 traumatic brain injury patients, including 52 mild and 25 moderate-severe injuries, by purposeful sampling in a regional teaching hospital from 15 August 2009 to 15 February 2010. Structural evaluation, including Glasgow Coma Scale (GCS), Rancho Los Amigos levels of cognitive function Scale (RLAS), Galveston Orientation and Amnesia Test (GOAT), of each patient will be recorded by interviews and observations on the day of admission and the day of discharge. Glasgow Outcome Scale - Extended (GOSE) was used to evaluate the functional outcome 3 months after the injury. After gathering the data, statistical analysis was processed by SPSS 17.0 software for mild and moderate-severe traumatic brain injury patients. Descriptive statistical analysis includes frequency-distribution, percentage, mean, and standard deviation; inferential statistics analysis includes paired-samples t test, simple regression, and multiple regression. The result of this study indicated that age was related to the outcome. After adjusting for the factor of age, the addition of GOAT or RLAS on the day of admission and the day of discharge increases predictive value of the 3 months functional outcome in patients with mild traumatic brain injury. However, only GCS on the day of discharge was predictive, in the group of moderate-severe traumatic brain injury patients. We recommend including RLAS and GOAT to the routine evaluation for patients of traumatic brain injury, which can offer additional information to medical groups and to know potential cognitive defects and possible preliminary outcome for the family and for discharge plans.

並列關鍵字

traumatic brain injury ； cognitive function ； functional outcome ； predictive validity.

參考文獻

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。

林家瑋、蔡宛真、邱文達、林天仁、江培業、林乾閔等(2004)•台灣地區外傷性顱內出血之研究•Journal of Emergence Critical Care Medicine, 15(1), 20-28.

邱艷芬(2000)•從腦灌流壓與腦組織的存活談頭部外傷病人的護理•護理雜誌，47(3)，59-63。

紀煥庭、邱文達、楊大羽、蔡行瀚(2007)•輕度頭部外傷之分類及危險因子•Journal of Emergence Critical Care Medicine, 19(2), 31-38。

Marr, A.L., & Coronado, V. G. (2002). Central nervous system injury surveillance data submission standards─2002. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention and National Center for Injury Prevention and Control.

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頭部外傷病患急性期認知功能評估對初期預後之預測效力探討

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