輕微頭部外傷病患之流行病學研究分析
Outcome and Epidemiology of Mild Brain Injury Patients
中文摘要頭部外傷是一個很重要的公共衛生問題。每年因頭部受傷導致殘障或死亡的人極 多，而頭部外傷中又以輕度頭部外傷（Mild Traumatic Brain Injury, MTBI）的患 者佔大多數。本研究主要針對輕度頭部外傷作流行病學分析，收集民國 90 年 7 月 1 日至 91 年 6 月 30 日，台北市 22 家醫院頭部外傷病患，共計 3,256 人。由 病歷報告中得知病人受傷的原因、顱內出血、痙攣、健忘及預後等情形。結果發 現輕度頭部外傷的患者中男性佔大多數（61.9%）。以年齡來看，發生在 20-29 歲 之間最多（23.7%）。受傷原因中車禍是主要的原因（47.1%），而跌落和遭人攻 擊分居於第 2、3 位。跌落情形中，滑倒最多（63.7%）。受傷情形中，顱骨骨折 佔 8.0%；意識喪失佔 19.7%；傷後健忘佔 4.1%；傷後有痙攣佔 1.8%；顱內出血 佔 21.1%，有 6.2%的輕度頭部外傷患者接受開顱手術。以顱內出血來看，性別、 年齡、受傷原因和顱骨骨折是導致輕度頭部外傷產生顱內出血的主要危險因子。 造成顱內出血的原因中，遭人攻擊(24.8%)及跌落(52.6%)為其主要的機轉。另外， 輕度頭部外傷顱內出血的病歷中，合併顏面骨折是沒有骨折的 0.29 倍；合併上 肢骨折是 0.36 倍；合併神經障礙是 2.49 倍；合併有意識喪失是 2.13 倍；合併有 顱骨骨折是 2.86 倍。輕度頭部受傷 6 個月後，多數傷者仍持續有頭痛、疲勞乏 力、頭暈等主觀症候；傷者在輕度頭部受傷後的日常居家和社交活動有減少的現 象。另外以預後而言，所有輕度頭部外傷中，大約有 10%的患者會導致死亡或殘 障。而以輕度頭部外傷合併顱內出血的病例中，則有約 20%會導致死亡或殘障等 嚴重後果，因此輕度頭部外傷是不容忽視的。 關鍵詞：輕度頭部外傷、顱內出血 英文摘要
Traumatic brain injury (TBI) has always been a concerned issue in the field of Public Health. The numbers of disability and death caused by TBI has a significant influence on society. Majority of the TBI patients were categorized under Mild traumatic brain injury (MTBI). The main purpose of this study is to analyze the epidemiology of MTBI. The present study will confer with the possible risk factors involved. The data includes 3,256 cases collected from 22 hospitals in Taipei City during 2001.7.1 - 2002.6.30. The following subject matters were analyzed from the data collected: The causes of injury; presence of intracranial hematoma or spasm; post-injury amnesia and final outcome. We found that males occupy the majority of the MTBI cases (61.9%). Ages 20-29 yr has the highest incidence rate (23.7%). Traffic accident was the major cause of MTBI (47.1%), followed by falling and assault respectively. Slip
and fall occupy the majority of the falling cases (63.7%). In the conditions of injury, skull fracture was found to occupy 8.0%, loss of consciousness 19.7%, post-injury obliviousness 4.1%, seizure 1.8%, intracranial hematoma 21.1%, and 6.2% cases received craniotomy. The main risk factors that caused intracranial hematoma in MTBI cases includes: sex, age, cause of injury, and skull fracture. Assault (24.8%) and falling (52.6%) were the major risk factors for the cause of intracranial hematoma. Also, the occurrence of intracranial hematoma in MTBI with facial bone fracture has 0.29 times more than those without it; the upper limbs fracture is 0.36 times; the neurological deficit is 2.49 times; loss of consciousness is 2.13 times; the skull bone fracture is 2.86 times. Six months after MTBI, most patients still have self-complaints of headache, fatigue, dizziness. Also, a decreased daily home activities and social activities were observed. As final outcome, about 10% of all MTBI cases will results in disability and death. And among those MTBI associated with intracranial
hematoma cases, there is approximately 20% cases result death and disability. Therefore, additional consideration should be given to MTBI, especially with significant awareness from health care providers.
