重症頭部外傷に続発する播種性血管内凝固症候群の検討

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Because of the hazard of further intracranial hemorrhage, heparin was not used in cases of disseminated intravascular coagulation (DIC) following head injury. A low dose (6,000-10,000 U./day) of heparin, however, could be safely administered without any risk of bleeding and was effective in the early treatment of the authors' series. Seven patients with DIC that occurred after severe head injury were studied. Of these, three had acute subdural hematomas, three had combined intracranial hematomas and one presented with cerebral contusion. All seven patients received either evacuation of intracranial hematoma or resec-tion of contused brain. DIC was diagnosed within the first 48 hours of injury in five patients and 4 days after injury in two. At the diagnosis the platelet counts were decreased (4.2-9.4X 10^4/mm^3) and FDP value was increased in all the patients. Hypofibrinogenemia was shown in four patients. Gastrointestinal bleeding was found in four patients, delayed intracerebral hematomas in two, and intracranial rebleeding in two. A low dose of heparin (6,000-8,000 U./day) was administered to six patients following the DIC diagnosis. The treatment was successful without any side effects, such as a bleeding tendency, in four patients. In two of these four patients, gastrointestinal bleeding improv-ed and the delayed or recurrent intracranial hematoma did not increase in three. Two patients died. One died from massive gastrointestinal bleeding. In this patient the coagulation studies were first performed 4 days after injury and the treatment in this instance started too late to improve the DIC. The present study suggests that the administration of a low dose heparin may be an effective therapy for patients with DIC following head injury.
日本脳神経外科学会の論文
1984-09-15

重症頭部外傷に続発する播種性血管内凝固症候群の検討

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