多発外傷を伴った頭部外傷の検討

DOI 被引用文献1件 参考文献20件
  • 本間 正人
    国立病院東京災害医療センター救命救急センター
  • 横田 裕行
    日本医科大学付属千葉北総病院脳神経外科
  • 小林 士郎
    日本医科大学付属千葉北総病院脳神経外科
  • 山本 保博
    日本医科大学付属病院高度救命救急センター
  • 大塚 敏文
    日本医科大学付属病院高度救命救急センター

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タイトル別名
  • Analysis of head injury patients with multiple trauma.

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Among the 22, 828 admitted patients, we had 8, 085 (35%) trauma patients, 3, 536 (16%) head injury patients, and 1, 280 (6%) head injury patients with multiple trauma in the Department of Emergency and Critical Care Medicine, Nippon Medical School and our related level I centers. Among 1, 280 patients, excluding 263 with cardiopulmonary arrest on arrival, 708 (70%) patients survived and 309 (30%) died. Head injury with multiple trauma was defined as head injury with at least one other system injury of abbreviated injury score (AIS)≥3. From the data on 220 patients receiving emergency operations, 4 subsets were established according to the Glasgow Coma Scale (GCS) 8 of consciousness and systolic blood pressure (sBP) of 90mmHg of on admission. In subset II (GCS>8, sBP≤90), hemorrhage control by an emergency exploration or transarterial embolization (TAE) should be given priority because of the low possibility of successful craniotomy (2%). In subset III (GCS≤8, sBP>90), immediate head CT scanning should be performed because of high possibility of successful craniotomy (91%). In subset IV (GCS≤8, sBP≤90), hemorrhage control should be done first, considering at the same time the possibility of an intracranial mass lesion because of the high possibility of carrying out both a torso operation (58%) and craniotomy (33%). In comparing head injury patients with multiple trauma and those without multiple trauma among 814 head injury patients, injury in the former group proved to be statistically more severe regarding the Injury Severity Score (ISS), Revised Trauma Score (RTS), amounts of transfusion, and lowest platelet count. However, head injury itself is the predominant factor for mortality. If the head injury is severe enough (head AIS≥3, an operation is needed, CT grade III or IV/traumatic coma data bank (TCDB). For the strategy for an intracranial mass lesion with multiple trauma, early definitive surgery is effective. Among the 1, 280 head injury patients with multiple trauma, emergency craniotomy was performed in 211. The survival rate after craniotomy and hematoma evacuation (54%) was better than that after burr hole and hematoma aspiration (17%). For the strategy for lesions without a mass effect with multiple trauma, early intracranial pressure (ICP) monitoring was adequate. Early ICP monitoring was performed for 64 patients. Eight of 9 (89%) patients survived because of the early detection of intracranial mass lesions by increased ICP. Multiple site synchronous operation can be helpful if life-threatening injuries exist in multiple parts of the body contemporaneously. But further control studies are needed to justify our strategy for head injury patients with multiple trauma.

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