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研究生:黃玲姿
研究生(外文):Ling-Tzu Huang
論文名稱:頭部外傷兒童之健康狀況
論文名稱(外文):Health Status of Children with Traumatic Brain Injury
指導教授:李淑貞李淑貞引用關係
指導教授(外文):Shwn-Jen Lee
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:物理治療研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2004
畢業學年度:92
語文別:中文
中文關鍵詞:健康狀況兒童頭部外傷
外文關鍵詞:Health StatusChildrenTraumatic brain injury
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摘要
研究背景與目的:頭部外傷是造成兒童功能損傷的重要原因。過去研究多數僅探討頭部外傷對兒童智力、記憶力、語言、行為、動作表現、學校功業表現、自我照顧能力和社交功能等造成的影響,但同時探討頭部外傷兒童身體生理與心理社會健康整體表現的研究相當缺乏。而學者也提出頭部外傷兒童受傷當時的嚴重程度、影像檢查結果、有無喪失意識、受傷當時年齡、性別、家庭狀況、或有無接受復健治療等都可能會影響頭部外傷兒童預後表現,但各個研究針對頭部外傷預後影響之因素仍有爭議。本研究之目的在探討頭部外傷兒童健康狀況,且進一步探討頭部外傷兒童健康狀況之影響因素。方法:本研究以台北地區四家醫院民國81年11月至92年11月頭部外傷0-14歲之兒童236位為研究對象,利用兒童生活品質評量表4.0台灣版來評估頭部外傷兒童健康狀況,並且收集頭部外傷兒童基本資料、住院就醫病歷記錄及出院後復健與家庭狀況等資料,作為影響頭部外傷健康表現相關因素之變項。結果:135位(57.2%)頭部外傷兒童完成健康狀況電話訪問。結果得知重度頭部外傷受試兒童之身體生理健康分數比心理社會健康分數低,輕度與中度頭部外傷兒童之心理社會健康比身體生理健康分數低,此外輕、中度頭部外傷兒童心理社會功能領域方面,最低分數為學校功能表現。出院後有無接受復健治療與家庭平均月收入因素,可解釋頭部外傷受試兒童健康整體表現之28.5%的變異量(F=6.399,p<0.001);出院後有無接受復健治療,可解釋頭部外傷受試兒童身體生理健康之35.2%的變異量(F=14.713,p<0.001);以及出院後有無接受復健治療與家庭平均月收入因素,可解釋頭部外傷受試兒童心理社會健康之16.8%的變異量(F=4.645,p<0.001)。本研究依據所得複迴歸分析模式中自變量之迴歸係數得知,出院後有接受復健治療之頭部外傷兒童的健康整體表現、身體生理健康和心理社會健康等方面,均較無接受復健治療之頭部外傷兒童為差;以及家庭平均月收入在2萬元以下之頭部外傷兒童的健康整體表現較家庭平均月收入在2萬元以上為差,其心理社會健康表現也較家庭平均月收入在4萬元以上為差。結論:重度頭部外傷兒童身體生理健康表現較差,輕度與中度頭部外兒童心理社會健康表現較差,且出院後有無接受復健治療及家庭平均月收入,為影響頭部外傷兒童健康狀況之重要影響因素。本研究建議針對不同嚴重程度之頭部外傷兒童,應及早規劃頭部外傷兒童醫療、特殊教育及社會資源輔助介入,以增進兒童之預後健康狀況表現。
關鍵詞:健康狀況,兒童,頭部外傷。
Abstract
Background. Traumatic brain injury (TBI) is a common cause that affecting the health status and functioning, and also results in disabilities, in children. Many studies have investigated different aspects in the scope of health status in children with TBI. But, there is a lack of studies that were able to provide full information of the scope of the health status in children with TBI, that is the physical and psychosocial health. Many studies found that the severity or CT findings of the brain damage, lost of consciousness, age at onset, gender, family conditions, and rehabilitation services received influenced the prognoses of children with TBI. But factors influenced the health outcomes of children with TBI were still controversial. Purposes. The purposes of this study were to investigate the health status in children with TBI and to explore the factors that influenced their health status. Study Design. A combined descriptive and exploratory research design was utilized for the study. Methods. This study recruited 236 children with TBI and with their age at onset of TBI between 0 to 14 years old. These subjects were admitted to one of the 4 hospitals in Taipei metropolitan area from November of 1992 to November of 2003. The inpatient medical records of diagnosis and intervention for TBI and their basic information in these children with TBI were retrieved from hospital charts. The parent proxy-report forms of the Pediatric Quality of Life inventory 4.0 Generic Core Scale (PedsQL 4.0) Taiwanese versions were used to measure the health status of children with TBI via telephone interview. The outpatient rehabilitation services received after discharged from hospitalization for the TBI and the personal and family information of children with TBI were also recorded via telephone interview. Descriptive statistics was used to describe the health status in children with TBI. Multiple regression analysis was then utilized to identify the factors, which influence health status in children with TBI. Results. This study completed successful telephone interview of the parent proxy-report on children health status of 135 children with TBI. In children with severe TBI, their physical health score was lower than that of the psychosocial health. In children with mild or moderate TBI, their psychosocial health was lower than that of the physical health. School function was the lowest score in the psychosocial health domains of children with mild or moderate TBI. Factors of the outpatient rehabilitation services received after discharged from hospitalization for the TBI and the family incomes could explain 28.5% of the variance in total health (F=6.399,p<0.001) and 16.8% of the variance in psychosocial health (F=4.645,p<0.001) of children with TBI. Factor of the outpatient rehabilitation services received after discharged from hospitalization for the TBI alone could explain 35.2% of the variance in physical health of children with TBI (F=12.419,p<0.001). Based on the multiple regression analysis, children with TBI received rehabilitation after discharge had worse total health, physical health and psychosocial health performance compared to those in children with TBI who did not receive outpatient rehabilitation services. Children with TBI whose average monthly family income below twenty thousand NT dollars were worse in total health than those with average monthly family income above twenty thousand NT dollars and were worse in psychosocial health than those with average monthly family income above forty thousand NT dollars. Conclusions. Children with severe TBI had poorer physical health, and children with mild or moderate TBI had poorer psychosocial health. Received rehabilitation after discharge and family income were the most important factors influence the health status of children with TBI. We suggested early medical, and special education intervention and social supporting program should be provided for children with TBI.
Key words:Health status, children, traumatic brain injury.
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