2007 年 30 巻 2 号 p. 127-132
Abnormal coagulation and fibrinolysis are a frequent complication in patients with severe head injury. Many studies have demonstrated that hemostasis tests are predictors of outcome in these patients. The aim of this investigation was to examine the clinical significance of coagulofibrinolytic abnormalities in patients with traumatic intracranial hemorrhage (TIH) complicated with and without multiple trauma.
Seventy four patients were diagnosed as TIH by initial CT scans performed within 24 hours after insult. Those were assigned into two groups: simple TIH (49 cases; Group S) and TIH with multiple trauma (25 cases; Group M). On admission, peripheral blood samples for coagulation studies (platelet count, fibrin-fibrinogen degradation products (FDP), fibrinogen) were taken. The results were compared with Glasgow Outcome Scale (good outcome: G.R., M.D., poor outcome: S.D., V.S., D.) at discharge in each group.
In the Group S, the FDP level was significantly higher in poor outcome patients compared with good outcome patients (p<0.001). In the Group M, there was no significant difference of FDP level between good outcome and poor outcome patients. The decrease of platelet count or fibrinogen was significant predictor of poor outcome in the Group M (p<0.05), but not in the Group S. Especially, the cause of death was uncontrollable bleeding leading to multiple organ dysfunction syndrome, in three of nine death in the Group M. FDP level was useful for evaluating neurological outcome. In the other hand, we speculated that platelet count and fibrinogen level were important predictors of the neurological outcome in the TIH included in the multiple trauma with a massive bleeding that caused coagulofibrinolytic abnormalities.
