創傷性脊髓損傷者一年內存活及影響因素

One-Year Mortality and Its associated Factors in Persons with Traumatic Spinal Cord Injury

陳姿怡(Chih-Yi Chen) ； 陳瑞杰(Ray-Jade Chen) ； 盧立華(Li-Hua Lu) ； 蔣永孝(Yung-Hsiao Chiang) ； 方禎鋒(Jen-Feng Fang) ； 李孟如(Meng-Ju Lee) ； 林茂榮(Mau-Roung Lin)

《物理治療》 31卷2期 (2006/04) Pp. 87-97

摘要

目標：探討創傷性脊髓損傷者受傷後一年內死亡及影響因素。方法：調閱台北及淡水馬偕醫院、林口長庚醫院、內湖三軍總醫院、及花蓮慈濟醫院1999/7/1至2004/6/30病歷，共有713位新發生創傷性脊髓損傷者。以衛生署死因資料庫及電話追蹤與確認個案死因，並使用比例式危險模式分析死亡的影響因素。另外，也與2001年台灣地區人口的死亡風險比較。結果：受傷一年內死亡率為11.7%。死因以非故意傷害、消化系統疾病、及腫瘤比例最高，分別為59.5%、6.8%、及6.8%。結果顯示年齡（危險比1.02，95%信賴區間1.01-1.04）、傷害嚴重度（危險比1.07，95%信賴區間1.06-1.08）與死亡風險有顯著相關；另外，相對於四輪機動車事故，機車（危險比1.66，95%信賴區間0.82-3.37）、腳踏車（危險比2.49，95%信賴區間0.69-8.97）、行人（危險比3.52，95%信賴區間1.28-9.71）、及跌落（危險比0.90，95%信賴區間0.45-1.82）等事故的死亡風險較高；相對於有運動功能且可抗重力者，感覺與運動功能全無者（危險比17.7，95%信賴區間9.04-34.7）、僅有感覺功能者（危險比8.68，95%信賴區間3.82-19.8）、及有運動功能但無法抗重力者（危險比3.09，95%信賴區間1.35-7.09）的死亡風險較高。結論：創傷性脊髓損傷者一年的死亡率較一般族群高，影響因素為年齡、受傷原因、神經損傷嚴重度、及傷害嚴重度。

關鍵字

脊髓損傷 ； 死亡 ； 死因 ； 傷害嚴重度

並列摘要

Objective: To examine one-year mortality and its determinants among persons with traumatic spinal cord injury (SCI) in Taiwan. Method: To recruit patients of SCI occurring during a 5-year period of from July 1, 1999 to June 30, 2004 by reviewing hospital records of 5 medical centers, including the Mackay Memorial Hospital at Taipei City and at Tamshui Town, Taipei County, the Chang-Gung Memorial Hospital at Linkou, Taipei County, the Tri-Service General Hospital, the Tzu Chi General Hospital at Hualien County, with codes of International Classification of Diseases. In addition to using the death registration of the Department of Health in Taiwan, follow-up telephone calls were also conducted to crosscheck the survival and causes of death among study subjects. The proportional hazards model was used to identify factors associated with the one-year survival. Results: A total of 713 subjects were recruited. The mortality rate of the first year after injury was 11.7% and three leading causes of death during the first year period were unintentional injuries (59.5%), diseases of the digestive system (6.8%), and cancers (6.8%). In the result of proportional hazards model analysis, the adjusted hazard ratio (HR) of death was associated with age at injury (HR=1.02, 95% confidence interval (CI)=1.01 to 1.04) and scores of the Injury Severity Scale (HR=1.07, 95% CI=1.06 to 1.08). Furthermore, the HR of the pedestrians to persons with motor vehicle injury was 3.52 (95% CI=1.28 to 9.71). Compared to persons with the level of motor function and key muscles grade of 3 or more, evaluated by American Spinal Injury Association Impairment Scale, those with no motor and sensory function, those with only sensory function, and those with motor function but key muscles grade less than 3, respectively, were 17.7 times (95% CI=9.04 to 34.7), 8.68 times (95% CI=3.82 to 19.8), and 3.09 times (95% CI=1.35 to 7.09) were more likely to die. Conclusion: The first-year mortality rate among traumatic SCIs is higher than the general population in Taiwan; it is still a room to be improved. Furthermore, the mortality is associated with age at injury, type of injury cause, and injury severity.

並列關鍵字

Cause of death ； Injury severity ； Mortality ； Spinal cord injury