多发伤中长骨骨折的治疗与脂肪栓塞综合征

脂肪栓塞综合征是骨折后严重并发症之一,多见于长骨骨折后,以呼吸困难、神经系统症状、发热及皮肤粘膜出血点为主要表现。严重创伤后肺部脂肪栓塞的发生率为９０％～１００％。脂肪栓塞发生后,多数患者表现为亚临床经过,仅少数发展为临床症状明显的脂肪栓塞综合征,甚...     

脂肪栓塞综合征胸部X线诊断(附12例报告)

目的　探讨脂肪栓塞综合征胸部X线诊断要点。方法　综合分析 1 2例长管骨骨折后脂肪栓塞的临床及胸部X线表现。结果　全部于创伤后 1 9～ 70h出现呼吸困难、中枢神经症状、皮肤出血点 ,部分出现血小板减少、尿或血中找到脂肪滴。胸片表现为双肺弥漫性分布斑片状阴影。结论　双肺弥漫性分布斑片状实变影是肺脂肪栓塞的X线特征     

脂肪栓塞综合征系列讲座(4) 脂肪栓塞综合征的防治

脂肪栓塞综合征的预防重于治疗，如Rokkamen等对多发性创伤患者在急诊室内即开始注射甲基氢化泼尼松，10mg／kg体重，8h1次，共3次。结果14例中仅1例发生FES，而未预防用药的15例中却有6例发生。我们认为对创伤骨折患者，伤后静脉输入右旋糖酐40（低分子右旋糖酐）500ml／d，既可增加血容量抗休克，又对脂肪栓塞综合征的预防有一定作用。另外，对严重创伤和多发性骨折患者，损伤局部的制动尤为重要，有人提出对长骨干骨折早期内固定，是预防脂肪栓塞综合征发生的重要措施。由于内固定稳定了骨折，从而减少或阻止了脂肪滴的释放和游离。1改…     

脂肪栓塞综合征(综述)

脂肪栓塞综合征(Fat EmbolismSyndrome,简称FES)是以急性呼吸功能紊乱为特征的、伴有脑部或全身症状的临床综合病征,常发生于严重创伤病人,导致病     

高压氧救治股骨干骨折合并脑型脂肪栓塞一例

脑脂肪栓塞综合征(FES)是严重创伤、骨折的早期危重并发症之一,常见于长骨和骨盆骨折、闭合性骨折.其临床特点为发热、心动过速、呼吸频率增快及呼吸困难等,以意识障碍为主,症状不典型,临床上比较少见,容易误诊和漏诊,且发病急骤,病情重、进展快、死亡率高,临床应引起重视.     

脂肪栓塞综合征4例的护理

<正> 脂肪栓塞综合征是创伤后的严重并发症,在各类骨折创伤后,其发病率约为7.7％。以肺脏内脂肪栓子比例最高。临床上绝大多数脂肪栓塞病例,仅有部分症状,而且病情轻微,但个别重型病例发病急骤,病势发展极为凶险,病死率很高,治疗护理较为困难。我科自1984年以来共治疗4例脂肪栓塞病人,全部抢救成功,现将护理体会介绍如下:     

脂肪栓塞综合征及其影像学表现

脂肪栓塞(fat embolism,FE)是由于循环血流中出现的脂滴阻塞于小血管所致的栓塞,常见于长骨骨折、严重脂肪组织挫伤或脂肪肝挤压伤时,脂肪细胞破裂,游离出的脂滴经破裂的小静脉进入血流而引起脂肪栓塞,脂肪栓塞的后果取决于脂滴的大小和多少以及全身受累的程度.脂肪栓塞综合征(fat embolism syndrome,FES)是血循环内的脂肪栓塞导致的以神经系统异常、呼吸衰竭及斑点状皮疹为主要表现的综合征,最常见的栓塞部位有肺、脑及皮肤.脂肪栓塞临床症状和检查无特异性,确诊率低、死亡率高.早期诊断脂肪栓塞可降低死亡率,减少额外费用.CT及MRI检查可以早期发现肺部及脑部病变,尤其是MRI已成为评估脑脂肪栓塞(cerebral fat embolism,CFE)最敏感的检查技术.笔者现就脂肪栓塞的流行病学、病理生理机制和临床表现进行综述,重点介绍肺及脑脂肪栓塞的影像表现.     

脂肪栓塞简易尿脂测定

脂肪栓塞综合征是创伤严重并发症，早期诊断意义重大。在处理这类病人中，我们研究的简易尿脂测定法能简单，迅速测出尿脂肪增高。与正常人对比差异显著，有助早期诊断。     

高压氧和药物治愈脑型脂肪栓塞综合征一例报告

脂肪栓塞综合征是创伤骨折后的严重并发症之一,治疗难度大,死亡率高。1984年5月,我们用高压氧和药物治愈一例以颅脑症状为主的典型脂肪栓塞综合征,经3年随访观察,无后遗症。现小结如下: 病例摘要:王××,男,21岁,汽车兵,住院号166812,因两汽车相撞,挤伤两大腿,     

脂肪栓塞综合征3例报告

探讨脂肪栓塞综合征的早期治疗。通过分析 3例骨折并发脂肪栓塞综合征 (FES)的临床资料 ,认为脂肪栓塞综合征的治疗重在预防 ,大剂量激素和白蛋白治疗非常重要     

Post-traumatic fat embolism in the inferior vena cava

Histologically, pulmonary fat embolism is seen in up to 97% of traumatized patients, yet almost all of them are asymptomatic. Although clinically significant, fat embolism syndrome is not common; it is a frequent cause of death when it does occur. The authors report the computed tomographic demonstration of fat embolism in the inferior vena cava of a patient who sustained multiple fractures. To their knowledge, no similar case has ever been described.     

Fettleber und Fettembolie

We report the case of a 77-year-old woman who was admitted to hospital with a relapsed vertebral compression syndrome due to herniation of the intervetrebral disk. Death occurred 2 days after admittance to hospital and the autopsy and histology revealed sepsis originating from purulent bronchopneumonia. In addition, pulmonary fat embolism grade II-III was present and was also detectable in other organs. The pathogenesis of fat embolism is discussed in the light of the literature. In the present case, postmortem findings in conjunction with the preceding clinical course favour the concept of a hepatic origin of fat embolism due to a pre-existing, partly cystic, fatty degeneration of the liver with spread of fat emboli from congestive liver parenchyma necrosis in the course of increasing right heart insufficiency. Pulmonary fat embolism was clinically relevant and contributed to the fatal outcome.     

脂肪栓塞综合征早期诊断方法

目的：探讨亚临床期脂肪栓塞的特点及诊断方法。方法：采用同种异体犬长骨骨髓脂肪静脉注射，建立实验模型。１４只健康杂种犬注射液体脂肪（０．７ｍｌ／ｋｇ）后，均发生脂肪栓塞综合征。结果：提出亚临床期脂肪栓塞综合征早期诊断新方法：从肺微血管血和周围静脉血中获取血凝块进行快速冰冻切片，经油红“Ｏ”染色后，镜检脂滴。经计算机图像分析证实，肺微血管中脂滴的数量和直径均明显高于周围静脉血。结论：本法具有较高的特异性和敏感性。结合动脉血氧分压下降，可作出亚临床期脂肪栓塞的早期诊断。     

Posttraumatic subarachnoid fat embolism: Case presentation and literature review

Fat embolism in the subarachnoid space has a unique pathophysiology and clinical picture when compared to fat embolism syndrome. Lipid deposits in the subarachnoid space—most commonly the sequela of dermoid rupture in the neuraxis—can cause an inflammatory reaction leading to irritation of nearby neurovascular structures. Herein, we report the only case in the United States, to our knowledge, of a patient diagnosed with subarachnoid fat emboli secondary to sacral fracture who initially presented with a normal head CT and subsequently developed visual changes.     

Pulmonary fat embolism after pelvic and long bone fractures in a trauma patient

Fat embolism is a common complication of pelvic and long bone fractures. Macroscopic fat emboli in the pulmonary arteries on computed tomography have been reported postoperatively after fixation of long bone fractures for trauma, however the quantification of attenuation values of fat emboli have been infrequently reported in the literature. We present a case of pulmonary fat embolism in a 52-year-old female after acute bony trauma sustained during a motor vehicle accident. To the authors' knowledge however, pulmonary fat embolism has not been described on the initial trauma CT scan.     

Radiological features of pulmonary fat embolism in trauma patients: a case series

Emergency Radiology - Fat embolism syndrome (FES) is a rare complication in trauma patients (usually with long bone fractures) in which migrating medullary fat precipitates multiorgan dysfunction,...     

骨盆骨折并髂血管损伤

目的 探讨骨盆骨折并髂血管损伤的早期诊治方法,方法 回顾性分析６年间收治的１２例骨盆骨折并髂管损伤病人的临床资料。结果 本组病人均有伴发伤及休克,其ＩＳＳ均大于１６分,平均３０．３２分,其中髂劝脉损伤１１例,髂外外动脉损伤１例,本组９例病人术后获救;死亡３例,死亡率为２５％,结论骨盆后 骶髂嵯节周围的严重损伤有时的会伴发致命的髂因管破裂,介入性血管栓塞技术及髂劝脉结扎术是救治创伤失血性休克的有效措     

MR imaging of the brain in fat embolism syndrome

Fat embolism syndrome (FES) is an uncommon but serious complication of traumatic injury and is frequently diagnostically challenging. In this paper, the authors present four patients who sustained lower extremity long bone injury and who had a normal Glasgow Coma Scale before orthopedic surgical intervention. However, postoperatively, significant neurological deterioration developed in these patients. While cranial computed tomography (CT) obtained immediately after surgery for acutely altered mental status was negative in two of the four patients, brain magnetic resonance imaging (MRI) demonstrated white and gray matter abnormalities accounting for the impaired neurological status in all cases. MRI findings in conjunction with clinical presentation established the diagnosis in all patients. MRI is indicated in any patient with orthopedic injuries who manifests an unexplained acute alteration in mental status, despite a normal head CT.     

创伤后静脉血栓症的预防研究进展

静脉血栓症(VTE)包括深静脉血栓形成(DVT)和肺栓塞(PE),是一种风险极高、潜在的致死性疾病,对于创伤患者更是如此。但VTE是可以预防的,目前已经有预防骨科择期手术VTE指南,但关于创伤患者预防VTE的临床证据尚显不足,为此笔者回顾了相关文献,对一些基本原则进行概述,并重点对预防措施和部分争论点进行综合分析。     

Experimental pulmonary fat embolism induced by injection of triolein in rats

The relationship between the volume of fat flowing in the bloodstream and the degree of pulmonary fat embolism has remained unclear. In this study, in order to examine whether the volume of fat particles in the bloodstream could be estimated from the degree of pulmonary fat embolism, 0.05, 0.1, 0.15, 0.2 and 0.25 ml of triolein were injected into male rats weighing 300-320 g, through the caudal vein. Consequently, it was noted that the severity of pulmonary fat embolism tended to gradually increase in proportion to the volume of injected triolein, with the severity of pulmonary fat embolism being significantly augmented by the injection of 0.2 and 0.25 ml of triolein, based on morphometric analysis. In application to human cases, about 60 ml of fat particles was estimated to flow into the bloodstream after the occurrence of a pelvic fracture. Moreover, the results of this study led to the hypothesis that the prognosis of pulmonary fat embolism is affected by the severity of preceding conditions which have caused fat embolism.