| 摘要: | 目的：中重度昏迷的創傷病患無法清楚表達不適，也無法對理學檢查產生適當生理反應，藉由全身性電腦斷層檢查能幫助醫療人員發現可能的潛在傷害，及早醫療介入處理。本研究調查中重度昏迷外傷病患後續需要安排全身性電腦斷層檢查的相關因素，期能協助醫療人員提早安排全身性電腦斷層檢查，及早治療。
方法：我們採用回溯性研究法，收取台北醫學大學市立萬芳醫院，於2011年7月至2015年6月，共48個月內所有到院時呈現中重度昏迷之創傷病患，蒐集急診診療前期可得到的資訊，再與病患接受的檢查（全身性電腦斷層或是單純腦部電腦斷層）做分析，歸納出與病患接受全身性電腦斷層檢查相關的因素，最後分析各項因素與病患預後的相關性。
結果：48個月期間，共有183位病患納入本研究，全身性電腦斷層檢查72例，腦部電腦斷層檢查111例。單變項分析結果，發現病患的年齡、性別、受傷機轉、受傷原因、病患轉送至急診的方式、初至急診時的檢傷分級、急診是否啟動外傷小組、急診第一次的格拉斯高昏迷指數(Glasgow coma scale, GCS)、不同的身體受傷部位、是否飲酒、血液中的麩草醋酸轉胺脢值等，與安排電腦斷層檢查的種類有關。進一步多變項邏輯回歸分析，發現高能量的受傷機轉、救護車紀錄中呈現中重度昏迷（GCS: 3-12）、胸腔受傷以及飲酒的族群，傾向於接受全身性電腦斷層檢查。另外，於急診接受全身性電腦斷層檢查、55歲以上、抵達急診時呈現重度昏迷、外傷嚴重度25分以上（injury severity score ≥ 25）以及輕中度白血球過高的病患，有較高的死亡率以及較差的出院意識狀態。
結論：雖然這個研究無法為中重度昏迷外傷病患制定出安排全身性電腦斷層檢查的條件，但仍提供診療初期用於預測病患後續全身性電腦斷層檢查的因素。未來研究仍需要驗證在參考這些因子，提早安排全身性電腦斷層檢查之後，是否中重度昏迷創傷病患的預後狀況能有顯著改善。
Background: Unconscious trauma patients cannot describe definite discomfort and have poor feedbacks to physical examinations that may result in significant injuries missed. Whole body computed tomography (WBCT) might help identify the occult lesions and make early treatment feasible. In this study, we investigated factors associated with WBCT arrangement and those with prognosis in unconscious trauma patients.
Methods: All unconscious trauma patients in Taipei Medical University Wan Fang Hospital, from July 2011 to June 2015, were enrolled. The clinical data prehospital data and early emergency department period were collected. Logistic regression model was used to identify significant factors for WBCT arrangement.
Results：There were 183 patients enrolled, of which 72 patients (39.3%) received WBCT and 111 patients (60.7%) received brain CT only. In the univariate analysis, age, gender, trauma mechanism, cause of injury, transferring method, triage priority, trauma team activation, Glasgow coma score at triage, injured area, blood alcohol level and serum glutamic-oxalocetic transaminase level were associated with WBCT arrangement. In the result of the multivariate logistic regression model, WBCT arrangement was significantly associated with high energy trauma mechanism, loss of consciousness at the scene, thoracic injury and alcohol drinking. Patients who received WBCT at the emergency department, and were older than 55 years old, under deep comatose status at triage, had injury severity score ≥ 25, and mild to moderate leukocytosis, were significantly associated with a higher mortality rate and poor discharge consciousness.
Conclusions：Although definitive indications of WBCT for unconscious trauma patients could not be established in this study, some significant factors during prehospital and early emergency treatment period were identified for WBCT arrangement. Further study is needed to confirm these results. |
