脂肪栓塞综合征在严重创伤患者延迟诊断的临床分析

李仁杰; 胡耑; 白祥军; 李占飞

doi:10.13201/j.issn.1009-5918.2014.01.009

脂肪栓塞综合征在严重创伤患者延迟诊断的临床分析

- 华中科技大学同济医学院附属同济医院创伤外科(武汉, 430030)

详细信息

通讯作者: 胡耑,E-mail:hd613@sina.com

中图分类号: R683

收稿日期: 2013-07-08

Clinical analysis for delayed diagnosis and treatment of fat embolism syndrome in severe-injured patients with long bone fracture

- Department of Traumatic Surgery, Tongji Hospital, Tongji Medical School of Huazhong University of Science and Technology, Wuhan, 430030, China

More Information

Corresponding author: HU Rui, E-mail: hd613@sina.com

Received Date: 08 July 2013

摘要

摘要: 目的:分析脂肪栓塞综合征(FES)在严重创伤患者中诊断延迟的原因,总结其诊治经验。方法:收集2007-01-2012-06我科收治多发伤患者5 074例,其中发生FES患者25例,其中10例出现早期漏诊导致诊断延迟,发生率为40%。总结了该组患者临床资料,分析其延迟诊治的可能原因、临床治疗和预防措施。结果:10例并发长骨骨折的多发伤患者均为严重创伤(ISS ≥ 16),伤后来我院就诊得到4~13 d明确诊断。最常见致伤原因为道路交通事故,其次为高处坠落和重物砸伤。10例患者中,7例治愈出院。2例转当地医院治疗,1例死亡,病死率10%。结论:提高对多发伤患者FES的认识,动态监测病情变化、及时处理骨折有助于减少创伤后脂肪栓塞综合征的发生。根据患者病情,选择恰当的治疗方案和内固定手术方式有助于改善创伤后脂肪栓塞综合征患者的预后。
- 多发伤 /
- 长骨骨折 /
- 腹腔室隔综合征
Abstract: Objective:To analyze the reasons for delayed diagnosis and treatment of fat embolism syndrome (FES) in patients with severe-injured,and to summarize the experience of diagnosis and treatment.Method:Clinical data of 25 severe-injured patients with FES admitted in our department during January 2007 to June 2012 were collected.There were 10 cases of misdiagnosis because of delayed in diagnosis.The etiology,diagnosis-treatment approaches and outcome of these patients were analyzed.Result:Ten cases of severe-injured patients were serious trauma (ISS ≥ 16),FES was diagnosed at 4~13 days after onset of trauma.Traffic accident injury was the most common causes of these patients,followed by falling and bruise injury caused by heavy object.Ten patients,7 cases were cured and discharged,2 cases were transferred to local hospital for treatment.There was 1 case death with mortality rate of 10%.Conclusion:Timely treatment and dynamic monitoring may help reduce the occurrence of fat embolism syndrome after trauma.According to patients condition,selecting the appropriate treatment and inner fixed operation method contribute to improve prognosis of post-traumatic fat embolism syndrome.
- multiple-injury /
- long bone fracture /
- fat embolism syndrome

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参考文献(13)

[1]	CHAN KM, THAM KT, CHIU HS, et al.Posttraumatic fat embolism:its clinical and subclinical presentations[J].J Trauma 1984, 24:45-49.
[2]	GURD A R, WILSON R I.The fat embolism syndrome[J].J bone joint surg (Br), 1974, 56:408-416.
[3]	TARIG S, AL-KHUWAITIR, ABDURAHMAN M, ALMOGHAIRI, SOPHIA M.Traumatic fat embolism syndrome[J].Neurosciences, 2003, 8:60-64.
[4]	WHITE T O, JENKINS P J, SMITH R D, et al.The epidemiology of posttraumatic adult respiratory distress syndrome[J].J Bone Joint Surg Am, 2004, 86:2366-2376.
[5]	MELLOR A, SONI N.Fat embolism[J].Anaesthesia, 2001, 56:145-154.
[6]	KONSTANTINOS PORPODIS, MICHAEL KARANIKAS, PAUL ZAROGOULIDIS, et al.Fat embolism due to bilateral femoral fracture:a case report[J].J Inter Gen Med, 2012:5:59-63.
[7]	KORHAN TAVILOGLU, Hakan Yanar.Fat Embolism Syndrome[J].Surg Today, 2007, 37:5-8.
[8]	GOSSLING H R, PELLEGRIN V D.Fat embolism syndrome.A review of the pathophysiology and physiological basis of treatment[J].Clin Orthop, 1982, 165:68-82.
[9]	TALBOT M, SCHEMITSCH E H.Fat embolism syndrome:history, definition, epidemiology[J].Injury.2006, 37S:3-7.
[10]	ROBINSON C M.Current concepts of respiratory insufficiency syndromes after fracture[J].J Bone Joint Surg Br, 2001, 83:781-791.
[11]	NUCIFORA G.HYSKO F.VIT A.Pulmonary Fat Embolism:Common and Unusual Computed Tomography Findings[J].Comput Assist Tomogr, 2007, 3l:806-807.
[12]	RODRIGO CAVALLAZZI, ANTONIO C?SAR CAVALLAZZI.The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs:a systematic review and meta-analysis[J].J Bras Pneumol.2008, 34 (1):34-41.
[13]	BABITA GUPTA, NITA D'SOUZA, CHHAVI SAWHNEY.Analyzing fat embolism syndrome in trauma patients at AIIMS Apex Trauma Center, New Delhi, India[J].J Emergencies Trauma and Shock I, 2011, 4:3-3.