두부외상 환자에서 혈액응고기전의 변화 = Coagulopathy in Head Injury

국문 초록 (Abstract)

1) 혈액응고이상의 빈도는 28.6%였으며, 의식이 GCS 9∼15인 군에서 24.2%, GCS 3∼8인 군에서 36.8%였다.
2) 치료결과가 좋지 못한 GOS 1∼3인 군에서 검사상 이상소견이 많았으며 특히 platelet count는 치료 결과가 나쁜 군에서 현저히 감소되어 있었다.
3) 두개강내 혈종이 없는 환자들에서 의식이 나쁜 군의 환자가 좋은 군의 환자에 비하여 혈액 응고의 이상이 유의성 있게 높았으며, 의식이 나쁜 군에서는 혈종이 없는 군에서 혈종이 있는 군보다 혈액응고 기전의 이상이 유의성있게 높았다.
4) 혈액응고의 이상이 있는 군과 없는 군간에 GCS에 따른 GOS은 유의성있는 상관관계가 없었다.
5) platelet count와 FDP를 제외한 전검사에서 3일만에 실시한 추적검사에서 거의 정상으로 회복되었다.

다국어 초록 (Multilingual Abstract)

Abnormal coagulation is a frequent complication in patients with head injury. Hemostasis in 56 patients with head injuries, not associated with serious systemic injuries, was screened using platelet count, bleeding time, prothombin time, thrombin time, activated partial thrombin time, fibrinogen level, fibrin degradation product(FDP), protamin sulfate test, ethanol gelation test, and d-dimer test. Frequency of coagulopathy was 28.6％ in all patients, 24.2％ in the group of Glasgow Coma Scale(GCS) 9~15, and 36.8％ in GCS 3~8. Patients with poor outcome, who had Glasgow Outcome Scale(GOS) 1~3, had higher frequency of abnormal laboratory results. Particularly, platelet was significantly reduced in the group of GOS 1~3 than GOS 4~5. In the patients without intracranial hematona, fequency of coagulopathy was significantly higher in the patients with poor outcome than favorable outcome. In the group of GCS 3~8, patients with hematoma had significantly higher frequency of coagulopathy than patients without hematoma. Coagulopathy did not significantly changed the outcome of the patients. Most of the results of the tests except platelet count FDP returned to normal limit on the follow-up tests done 3 days later.