Sawauchi S, Yuhki K, Abe T
Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461, Japan.
No Shinkei Geka. 2001 Feb;29(2):131-7.
It has long been recognized that a traumatic insult to brain tissue may result in substantive coagulation abnormalities. The present study was carried out in an attempt to find out the association of coagulopathy and the development of delayed traumatic intracerebral hematoma (DTICH) in patients diagnosed with a traumatic subarachnoid hemorrhage (TSAH). Sixty-three patients were diagnosed as having TSAH from the initial CT scans obtained within 2 hours after trauma. On admission, peripheral blood samples for coagulation studies were taken within 6 hours after injury. All patients had subsequent CT scans performed within 24 hours of admission. Thirty (47.6%) of 63 patients exhibited radiological evidence of DTICH on their subsequent CT scans. There was a significant correlation between the increased value of serum fibrinogen degradation product (FDP > 40 micrograms/ml) and the development of DTICH. We observed that the origin of the hematoma might be caused by those radiographically unidentifiable parenchymal lesions often found with TSAH on the initial CT scan. We conclude that a clotting study at the time of admission is of value in predicting the occurrence of DTICH associated with TSAH.
长期以来，人们已经认识到对脑组织的创伤性损伤可能会导致实质性凝血异常。本研究旨在探讨创伤性蛛网膜下腔出血（TSAH）患者凝血功能障碍与迟发性创伤性脑内血肿（DTICH）发生之间的关联。63例患者通过创伤后2小时内获得的初始CT扫描被诊断为TSAH。入院时，在受伤后6小时内采集外周血样本进行凝血研究。所有患者在入院后24小时内均进行了后续CT扫描。63例患者中有30例（47.6%）在后续CT扫描中显示出DTICH的影像学证据。血清纤维蛋白原降解产物增加值（FDP>40微克/毫升）与DTICH的发生之间存在显著相关性。我们观察到血肿的起源可能是由初始CT扫描上TSAH常见的那些影像学上无法识别的实质病变引起的。我们得出结论，入院时进行凝血研究对于预测与TSAH相关的DTICH的发生具有价值。
