台灣地區2005至2008年創傷性脊髓損傷之流行病學研究

• Main Authors: 莊美芳, Chuang，Mei- Fang
• Other Authors: 傷害防治學研究所, 邱文達
• Format: Thesis
• Language: Chinese; English
• Published: 2010
• Subjects: 創傷性脊髓損傷；流行病學；受傷原因; Traumatic spinal cord injury；Epidemiology；Causes of injury; Alaranta; Canada; Keller; Levy; Moreno; Neves; O'Connor; Parry; Pedersen; Pickett; Saunders; Iceland
• Online Access: http://libir.tmu.edu.tw/handle/987654321/36279; http://libir.tmu.edu.tw/bitstream/987654321/36279/1/tmu-99-M513097009-1.pdf

表目錄.i 圖目錄.ii 第一章 緒論.1 第一節、研究背景及動機.1 第二節、研究目的.3 第三節、名詞定義.4 第二章 文獻探討.7 第一節、創傷性脊髓損傷之定義.7 第二節、創傷性脊髓損傷發生率與死亡率探討.8 第三節、創傷性脊髓損傷之年齡與性別探討.11 第四節、創傷性脊髓損傷之損傷原因探討.13 第五節、創傷性脊髓損傷之脊髓損傷部位及障礙型態.15 第三章 材料與方法.17 第一節、研究對象.17 第二節、資料分析.18 第三節、統計分析.19 第四章、研究結果.20 第一節、創傷性脊髓損傷發生率及基本人口學資料分佈情形.21 第二節、創傷性脊髓損傷患者受傷原因探討.23 第三節、創傷性脊髓損傷患者受傷情形分佈.24 第四節、創傷性脊髓損傷患者神經障礙程度分佈以及住院天數 分析.26 第五節、創傷性脊髓損傷患者受傷結果分析.28 第六節、各危險因子與病患出院時神經障礙程度之相關性.31 第五章、討論.33 第六章、研究限制.38 第七章、結論與建議.39 參考文獻.40 附表.46 附圖.52 附件.76 表目錄 表2-2-1、各國創傷性脊髓損傷之發生率.46 表2-2-2、各國創傷性脊髓損傷之死亡率.47 表2-3、各國創傷性脊髓損傷患者之平均年齡與性別比. .48 表2-4、各國創傷性脊髓損傷患者之受傷原因. .49 表2-5、各國創傷性脊髓損傷患者之受傷部位及神經障礙程度之比例.50 表3-1-1、合作醫院列表.51 表3-1-2、脊髓損傷ICD-9項目.52 表4-1、976位脊髓損傷患者基本人口學特性與受傷原因.53 表4-2、性別、年齡與受傷原因之分佈.57 表4-3-1、受傷情形之分佈.59 表4-3-2、性別、年齡、受傷原因與受傷部位之分佈.62 表4-4-1、受傷部位與脊髓神經障礙種類之分佈.64 表4-4-2、住院天數之分佈.65 表4-4-3、脊髓神經障礙種類與加護病房住院天數之分佈.67 表4-5-1、受傷結果.68 表4-5-2、性別、年齡、受傷原因、受傷部位、脊髓神經障礙種類與受傷結果之分佈.70 表4-5-3、性別、年齡、受傷原因、受傷部位、脊髓神經障礙種類與受傷結果(死亡與植物人)之分析.74 表4-6、影響脊髓神經障礙之危險因子. .75 圖目錄 圖4-1-1 受傷年份分佈.54 圖4-1-2 年齡分佈.54 圖4-1-3 性別分佈.55 圖4-1-4戶籍地分佈.55 圖4-1-5 受傷原因分佈.56 圖4-1-6 受傷者所乘座之車型.56 圖4-2-1 性別與受傷原因.58 圖4-2-2 年齡與受傷原因.58 圖4-3-1 受傷部位分佈.60 圖4-3-2 合併傷害部位分佈.60 圖4-3-3脊髓神經障礙種類分佈.61 圖4-3-2-1 性別與受傷部位.62 圖4-3-2-2年齡與受傷部位.63 圖4-3-2-3 受傷原因與受傷部位.63 圖4-4-1 受傷部位與脊髓神經障礙種類.64 圖4-4-2-1 加護病房和普通病房的平均住院天數.65 圖4-4-2-2加護病房住院天數分佈.66 圖4-4-2-3普通病房住院天數.66 圖4-4-3-1脊髓神經障礙種類與加護病房住院天數.67 圖4-5-1-1受傷結果.68 圖4-5-1-2死亡原因.69 圖4-5-1-3 受傷後醫學合併症.69 圖4-5-2-1 性別與受傷結果.71 圖4-5-2-2 年齡與受傷結果.71 圖4-5-2-3受傷原因與受傷結果.72 圖4-5-2-4 受傷部位與受傷結果.72 圖4-5-2-5脊髓神經障礙種類與受傷結果. .73 1. 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Paraplegia 1993; 31: 398-403. 61.林樹基,林茂榮,蔡卓城,蔡行瀚,江富偉,李蔚貞, 邱文達 台北市交通事故和跌落導致急性脊椎傷害病人的特質比較 J Emerg Crit Care Med. 2009; 20:183-194 62.陳姿怡,陳瑞杰,盧立華,蔣永孝,方禎鋒,李孟如,林茂榮 創傷性脊髓損傷者一年 內存活及影響因子 FJPT 2006;31(2):87-97 碩士 指導教授-邱文達 委員-白璐 委員-蔣明富 目的：針對創傷性脊髓損傷患者其基本資料及受傷經過作描述性的統 計分析，並深入探討相關危險因子與損傷嚴重度的差異性及預 後結果的相關性 方法：本研究之研究對象是來自「中華民國頭脊髓外傷研究小組」所 收集之創傷性脊髓損傷資料庫，此資料庫包含合作醫院中花蓮 縣4家與台北市20家區域級以上中大型醫院之創傷性脊髓損傷 病患，合計共976人。資料以SPSS15版套裝軟體整合相關資 料進行分析，類別變項資料使用卡方檢定(Chi-Square)檢驗，另外也使用邏輯式迴歸分析來檢測危險因子與受傷嚴重度的相關性。以P值小於0.05為顯著差異的標準。 結果：近二年創傷性脊髓損傷患者有稍減，平均受傷年齡49.31歲，男女性比為2:1，受傷原因皆以車禍為主，受傷部位以頸椎最多占68.3%，脊髓神經障礙種類以四肢不完全癱居多25.1%，合併傷害部位以頭部外傷占70.9%，加護病房平均住院天數5.6天，受傷結果死亡8.3%、神經障礙種類造成之受傷結果以無行動障礙且能獨立居多57.2%，進一步以受傷結果(死亡及植物人)與脊髓神經障礙種類作分析以其他脊髓神經障礙作為參考族群，四肢全癱的患者較為死亡與植物人的風險為參考族群0.78倍，達統計學上顯著差異(95%CI:1.04-90.01)。 結論：創傷性脊髓損傷其所衍生的神經學後遺症及殘障，會對傷者本身及其家庭造成相當大的生活負擔，而長期醫療照護與復健的開銷，更是龐大的社會經濟負擔，也威脅整個國家的經濟發展力，因此要降低創傷性脊髓損傷的發生率與死亡率，必須針對相關危險因子進行介入措施，如降低行車超速與酒後駕車的行為，預防老人跌落所造成的傷害，同時也要加強緊急醫療救護及復健醫療照護，因其照護品質的優劣會影響到傷者的存活與預後情形的重要因素，使脊髓損傷患者能獲得及時與適當的醫療照護以延長壽命，並降低社會醫療成本。 Goals: To provide descriptive characteristics and history of the traumatic events for patients with traumatic spinal cord injuries. This study further examined the associations between risk factors and severity and prognosis of the injuries. Methods: Study subjects included 976 patients with traumatic spinal cord injuries in the Taiwan National Head Injury Database collected (time period?) by the Head and Spinal Injury Research Team. This Database collected data from 4 hospitals in Hualien County and 20 regional hospitals in Taipei City in Taiwan. Chi-square statistics and logistic regressions were used. All analyses were conducted using statistic software SPSS15 with a significance level of 0.05. Results: There was a decrease in incidence of traumatic spinal cord injuries in the past two years. The average age of patients was 49.31 years. Males were twice more likely than females to encounter the injuries. The main cause of the injuries was automobile accidents. About 68.3% of the injuries occurred in neck spinal cord. Partial paralysis of four limbs was among the most prevalent injuries, accounting for more than one quarter (25.1%). Most (70.9%) of injuries occurred in head. The average length of stay in intensive care units was 5.6 days. About 8.3% of the patients died. More than half (57.2%) recovered with no limitations in movement and were able to live independently. Compared to those with other spinal cord injuries, patients with complete paralysis of four limbs were statistically significantly 0.78 times more likely to die or in vegetable status (95%CI1.04-90.01). Conclusions: The impacts of traumatic spinal cord injuries not only impose tremendous burdens for the patients and their families, but also for the society as a whole. Therefore, the study of traumatic spinal cord injuries was among the top priority worldwide. To reduce the incidence and mortality of the traumatic spinal cord injuries, it is warranted to focus interventions on the risk factors. Examples include decrease in speeding or driving under influence and fall prevention for the elderly. Furthermore, it is necessary to strengthen the emergency medical care and rehabilitation care systems, which play significant roles in the survival and prognosis of patients as well as the improvement of nationwide traumatic spinal cord care system. As a result, patients with traumatic spinal cord injuries may receive timely and adequate care, prolong their lives. The country may reduce the medical care costs.