重症頭部外傷の臨床像：びまん性脳損傷と局所性脳損傷との比較

抄録

Introduction: To fully understand the pathology of head injury, we categorize severe head injury on the basis of injury type, and we compare clinical factors and biochemical markers between groups.

Subjects: A total of 55 patients with a mean age of 54.9 years (range, 15 – 84 years) were enrolled in the study after excluding those who died within 24 h of arrival, those with cardiopulmonary arrest on admission, and those with a Glasgow Coma Scale (GCS) score of ≤ 8.

Methods: Patients were divided into groups on the basis of diffuse injury (D), evacuated mass lesion (E), and non-evacuated mass lesion (NE) in accordance with National Traumatic Coma Data Bank (TCDB) computed tomography (CT) scan classification. Factors such as age, sex, GCS value, cause of injury, mortality rate, Glasgow Outcome Scale (GOS) value, coagulation factors, inflammatory condition, and escaped enzymes were compared, and the Student's t-test was used for statistical analysis.

Results: The number of patients in groups D, E, and NE was 28, 26, and 1, respectively. The mean age was 52.3 years and 58.8 years in groups D and E, respectively. With regard to cause of injury, group D had an overwhelmingly high rate of traffic-related injury. The mortality rate was 7% in group D and 23% in group E. A comparison of biochemical markers revealed that while LDH was significantly high in group D, group E had significantly high stress index (Glu/K) levels. In addition, group E tended to have more severe coagulation abnormalities.

Discussion: Group D patients were characterized by relatively young age and high-energy trauma. Despite minor coagulation abnormalities and a low mortality rate, the patients had poor functional outcome. On the other hand, group E patients presented with multifactorial injuries, such as different forms of hematomas, and it was therefore difficult to identify specific characteristics.