重症多発外傷患者における凝固線溶異常と頭蓋内血腫の拡大

Enlarging of Intracranial Hemorrhagic Lesions and Coagulofibrinolytic Abnormalities in Multiple-Injury Patients

I．はじめに

　近年中枢神経系の損傷部位および程度が正確に把握でき，また治療法の選択も的確に行いうるようになり，頭部の単独外傷の生命予後はGlasgow Coma Scale（G．C．S．）6以下の重症例を除いて著明に改善された^1）．しかし重篤な多発外傷例においては合併損傷に由来する病態が予後に大きな影響をおよぼす場合が少なからず経験され，病態の把握や治療の面で多くの未解決の問題が残されている．本報告では全身性外傷を合併した頭部外傷患者のうち凝固線溶系の異常を呈した例における頭蓋内出血病変の経時的変化について検討した．

The clinical course of ten cases of head injury com-plicated with multiple systemic injuries were studied by comparing two groups divided according to the pre-sence or absence of associated coagulofibrinolytic abnormality. All these cases had intracranial hemorrha-gic lesions proven by the high density area in the initial CT scan. Five cases showed signs of disseminated in-travascular coagulation (DIC) as evidenced by de-creased counts of platelet, and/or elevated value of FDP at the time of admission. Four cases out of these five were in a state of hemorrhagic shock.