Ulus Travma Acil Cerrahi Derg. 2010; 16(3): 198-202

Çoklu travmalarda koagülopati

Muhammet Gökhan Turtay¹, Vedat Kýrýmlýoðlu², Cengiz Ceylan^3
1Ýnönü Üniversitesi Týp Fakültesi, Acil Týp Ana Bilim Dalý, Malatya
²Ýnönü Üniversitesi Týp Fakültesi, Genel Cerrahi Ana Bilim Dalý, Malatya
³Atatürk Devlet Hastanesi, Ýç Hastalýklarý Servisi, Aydýn

AMAÇ
Erken dönemde genel vücut travmalý (GVT) hastalarda, kafa travmasýnýn ve diðer bölge travmalarýnýn koagülasyon üzerine etkisi ve bu hastalarda koagülasyon parametreleri ile Glaskow Koma Skoru (GCS) ve travma þiddet skoru (ISS) iliþkilerinin araþtýrýlmasý amaçlandý.
GEREÇ VE YÖNTEM
Acil servise GVT ile baþvuran, 50 hasta (9 kadýn, 41 erkek) çalýþmaya alýndý. Hastalarýn GCS, ISS, koagülasyon parametreleri düzeyleri belirlendi. GCS, ISS ile koagülasyon parametreleri arasýnda korelasyon deðerlendirildi. Hastalar; önemli bir travma tespit edilmeyen (A), sadece kafa travmasý olanlar (B), kafa travmasý ve diðer bölge travmasý olanlar (C), kafa travmasý olmayan ancak diðer bölge travmalarý olanlar (D) olarak ayrýldý.
BULGULAR
ISS ile uluslararasý normalize oraný (INR), aktif parsiyel tromboplastin zamaný (aPTT), D-dimer ve fibrin yýkým ürünleri (FDP) düzeyleri arasýnda pozitif, ISS ile antitrombin (AT) ve fibrinojen düzeyleri arasýnda negatif bir iliþki saptandý (p<0,05). C grubuyla diðer gruplardaki INR, D-dimer, fibrinojen, aPTT, AT parametreleri karþýlaþtýrýldýðýnda istatistiksel anlamlýlýk saptandý (p<0,05). Kafa travmasý olan ve olmayan gruplar arasýndaki INR, D-dimer ve fibrinojen parametrelerinde istatistiksel anlamlýlýk saptandý (p<0,05).
SONUÇ
Kafa travmasý olan hastalarda koagülasyon parametrelerinin bozulduðu, ancak kafa travmasýna diðer bölge travmalarý eþlik ettiðinde koagülasyon parametrelerinin daha fazla anormalleþtiði belirlendi.

Anahtar Kelimeler: Koagülasyon, travma þiddet skoru; genel vücut travmasý.

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Coagulopathy in multiple traumas

Muhammet Gökhan Turtay¹, Vedat Kýrýmlýoðlu², Cengiz Ceylan^3
1Department Of Emergency Medicine, Inonu University, Malatya, Turkey
²Department Of General Surgery, Inonu University, Malatya, Turkey
³Department Of Internal Medicine, Atatürk State Hospital, Aydin, Turkey

BACKGROUND
This study aimed at analyzing the effect on coagulation of head trauma and other local traumas in patients exposed to multiple traumas in the early stage, and also the relations of Glasgow Coma Scale (GCS) and Injury Severity Score (ISS) with coagulation parameters in these patients.
METHODS
Fifty consecutive patients (9 women, 41 men) with multiple traumas were included in this study. The GCS, ISS and coagulation parameter levels were measured. Presence of a correlation between GCS and ISS with coagulation parameters was analyzed. Patients exposed to multiple traumas were assessed in four categories as the patients with no significant traumas (A), only head traumas (B), head trauma and other local traumas (C), and no head traumas but other local traumas (D).
RESULTS
A marked relationship was found between ISS and international normalized ratio (INR), activated partial thromboplastin time (aPTT), D-dimer, fibrin degradation product (FDP), antithrombin (AT), and fibrinogen (p<0.05). There was a statistically significant difference between Group C and the other groups in INR, D-dimer, fibrinogen, aPTT, and AT parameters (p<0.05). There was also a statistically significant difference between the groups with and without head trauma in INR, D-dimer and fibrinogen (p<0.05).

CONCLUSION
The coagulation parameters were observed to diverge in patients with head trauma, but in cases with head injuries accompanying other local traumas, more coagulation parameters became abnormal.

Keywords: Blood coagulation, Injury Severity Score; multiple traumas.

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