原著
重症頭部外傷に対する初療室穿頭術53例の検討
2013 年 36 巻 2 号 p. 188-195
詳細
2013 年 36 巻 2 号 p. 188-195
Purpose: We examined the usefulness and limitations of burr-hole surgery in the emergency room by retrospectively investigating the characteristics and outcomes of patients who underwent the burr hole surgery for traumatic severe brain injury.
Methods: A total of 53 patients underwent burr-hole surgery in the emergency room. We analyzed a preoperative factors such as GCS score on admission; systolic blood pressure; pupil findings; blood tests (fibrin degradation product (FDP), D-dimer); morphology of hematoma; ICP immediately after burr-hole surgery; and the mean interval from contact to emergency service to burr-hole surgery. Patients were devided into groups on the basis of diffuse injury (DI) groups and evacuated mass lesion (EM) groups in accordance with National Traumatic Coma Data Bank (TCDB) classification. Student's t-test and Fisher's exact probability test as statistical analysis were conducted with a significance level of p<0.05.
Results: 1) FDP and D-dimer were significant prognostic factors in all patients; 2) survival following burr-hole surgery alone was common among DI group with mild impairment of the coagulopathy and no extensive brain swelling, and in whom ICP could be controlled with subdural drainage; 3) survival following additional craniotomy following burr-hole surgery alone was common among EM group with mild impairment of the coagulopathy and mild brain parenchymal injury; 4) in patients with a GCS score of 3, FDP and D-dimer were significant prognostic factors; and 5) patients with shock, such as complication by pelvic fracture, experienced particularly poor outcomes.
Conclusion: Burr-hole surgery in the emergency room was considered useful for the following purposes: 1) quick reduction of intracranial pressure at an early stage prior to craniotomy in the EM group; and 2) managing hematomas and controlling ICP with cerebrospinal fluid drainage in the DI group. 3) Survival was possible under certain conditions, even in the most severe cases such as GCS score of 3.
