頭部外傷患者健康相關生活品質之探討
Assessing Health-related Quality of Life
中文摘要 健康相關的生活品質研究已成為一個十分熱門的話題，生活品質代表的是疾病對 病人整體的影響，目前已逐漸成為各類疾病治療成功與否的一個重要指標。頭部 外傷病患會因不同受傷程度，而有身體、認知、行為、情緒和社會等問題的差異； 頭部外傷也會導致認知功能障礙。而頭部外傷病患，有些常無法完全治療，必須 長期醫療控制，因此與健康相關的生活品質對於頭部外傷病患的重要性更不言而 喻。本研究選擇北台灣 22 家醫院，受傷時間為 2002 年 1 月 1 日至 2003 年 6 月 30 日，因創傷性頭部外傷而就醫的患者，年齡為 18 歲以上。隨機抽選出 676 位， 之後採用台灣簡明版世界衛生組織生活品質問卷（World Health OrganizationQuality of Life questionnaire，簡稱 WHOQOL-BREF），以電話訪視方式收集到 135
位。結果顯示由傷害嚴重度來評估生活品質各範疇均不顯著，但由延伸轉歸評分
（Extended Glasgow Outcome Scale, GOSE）（是八點評分法，將 Glasgow Outcome
Scale(GOS)復原的程度更加細分，也就是把每一類有意識的存活狀況在分成兩個 等級，主要是以意識狀況、在家中的獨立性、離家在外的獨立性、工作、社交及 休閒活動、和家庭及朋友關係等為評估的指標。）來評估生活品質各範疇均達到 統計上顯著，但經過訪視時間點的分層分析，受傷後未滿一年，發現輕度頭部外 傷病患的生活品質較高，在社會關係、環境範疇有達到統計上的差異（P＝ 0.007,0.027）；受傷後一年以上，發現嚴重及中度頭部外傷病患的生活品質較高， 在環境範疇有達到統計上的差異（P＝0.025）。在高度復原良好（Upper GR）的 頭部外傷患者，其生活品質每一個範疇都有較高的分數；顯示 GOSE 對於頭部 外傷患者受傷後的預後評估與 WHOQOL-BREF 問卷的結果一致，可作為良好的 預後評分標準。 英文摘要
The health correlation and quality of life research has become an extremely popular topic, the quality of life represents the total effects the disease has on the patient. It is gradually becoming a standard or symbol for either successful or unsuccessful treatment of different classes of disease. Patients with mild, moderate or severe brain injuries suffer from physical, cognitive, behavioral, emotional and social problems. External head injuries can cause the cognition function barrier. Often times, external head injuries are not completely treatable and must use long-term medical control, consequently the importance of health related quality of life research is even more so evident. This research chose 22 hospitals from northern Taiwan, time of injury from January 1, 2002 to June 30, 2003, hospitalized because of the external head injuries,
and with age 18 years old and above. 676 individuals were randomly chosen to make use of the World Health Organization Quality of Life questionnaire, or called
WHOQOL-BREF, by the making telephone calls to collect a total 135 samples. The result showed that by using the level of injures to evaluate the various categories of quality of life did not show any statistical value, but by using Extended Glasgow Outcome Scale (GOSE) (it is the eight-point, to use GOS subdivide the upper three categories of the scale. These criteria evolved through pilot work and, in the final version, they are easy to apply and reliable, and give a division of the patients in each category.) to evaluate the quality of life achieved statistical results. But through the telephone time survey analysis, those injured for less then one year showed that patients with mild head injuries demonstrated a higher quality of life in the environment and society category has achieved statistical significance (P = 0.007,0.027); Those injured for more than one year, discovered that moderate and severe head injured patients had a higher quality of life and has achieved statistical significance in the environment category (P = 0.025). Head injury patients with upper good recovery presented higher score in all domains of quality of life. The evaluations of prognosis between GOSE and WHOQOL-BREF questionnaire were consistent. GOSE could be a good instrument of prognosis evaluating.
