骨创伤并发脂肪栓塞综合征损伤严重度预警参数探讨

目的：探讨骨创伤并发脂肪栓塞综合征（ FES）损伤严重度预警参数。方法采取回顾性分析方法,应用损伤严重度改良评分法（ RISS）对1993年1月～2009年11月收治的47例骨创伤并发FES患者进行定量评估,探讨其损伤严重度值域范围。结果全部病例RISS评分均在11分以上：单纯多发性骨创伤6例,RISS值位于11～18;伴有颅脑或胸腹腔内脏器损伤的多发性骨折患者有38例,RISS分值在18～25,3例分值＞25分。 FES发生与RISS分值呈正相关（P＜0.05）。结论骨创伤损伤严重度与FES发生之间具有相关性,当单纯多发性骨创伤患者RISS值≥11、伴有颅脑或胸腹腔内脏器损伤的多发性骨折RISS值≥18时,易发生骨创伤并发FES,应采取预防措施。     

救治严重创伤性脂肪栓塞综合征2例

本文对在贵州广泛分布的喀斯特灌丛植被的区系成分、生活型和生态类型等特征进行了分析研究。结果表明：喀斯灌丛的区系成分以北温带分布式为主；生活型的构成则较为复杂；生态类型则以专性钙土植物与喜钙植物最具代表性。     

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。     

用骨髓脂肪建立脂肪栓塞综合征动物模型

观察脂肪栓塞综合征动物模型表明：①犬的静脉血凝块冰冻切片油红Ｏ染色，可以找到桔红色的脂滴，并可计算出脂滴数量和大小；②取实验犬的肺组织冰冻切片油红Ｏ染色，也可看到大量的桔红色脂滴沉着于肺组织内；③用气相色谱法检测血浆游离脂肪酸时，发现静脉注射骨髓脂肪后游离脂肪酸明显升高；④犬的动脉血氧分压下降，当降至７．９９±０．３０ｋＰａ时，犬出现呼吸困难等症状。上述结果说明，用骨髓脂肪静脉注射建立脂肪栓塞综合征的动物模型是可靠的。     

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     

脂肪栓塞综合征25例分析

目的：探讨脂肪栓塞综合征的发病机制、早期诊断指标及治疗措施。方法：分析25例脂肪栓塞综合征病人的临床表现及诊治过程。结果：本组中1例死亡、1例出现脑梗塞后遗症，其余均完全康复。中枢神经系统症状和呼吸系统症状的出现率最高，分别为88％和80％。结论：脂肪栓塞综合征的诊治中要重视氧饱和度及动脉氧分压监测，注意观察中枢神经系统症状和呼吸系统症状可早期诊断，纠正低氧血症为治疗的重点。     

脂肪栓塞综合征五例报告

脂肪栓塞综合征（简称FES）是骨折后常见的合并症，本文报导五例，临床资料见表：     

Cerebral fat embolism syndrome after long bone fracture: A case report

Cerebral fat embolism is a rare and potentially fatal condition that may occur following a long bone fracture. Its characterized by respiratory, neurological, and mucocutaneous signs. Isolated severe brain syndrome remains exceptional. We report a 21-year-old male patient admitted for the cerebral manifestation of a fat embolism syndrome due to a fracture of long bone after a traffic accident injury. Neurological deterioration after a free interval was seen with generalized tonic-clonic seizures. MRI of the brain was indicated which showed numerous multifocal hyperintensities involving the deep white matter of both hemispheres producing a “starfield” appearance. This pattern of cytotoxic cerebral edema, with lesions in the white matter rather than the grey matter, is indicative of the subacute stage of fat embolism. The patient was treated with comprehensive support in the intensive care unit, he returned to normal neurological function and was discharged after 3 weeks of hospitalization.     

脂肪栓塞综合征的诊断和治疗

目的 探讨脂肪栓塞综合征(FES)的诊断和治疗。方法对41例脂肪栓塞综合征的诊断、治疗进行回顾,统计、分析了主要症状出现的频率,并将治疗结果与以前的相关文献进行比较。结果41例皆有意识障碍、皮肤粘膜出血点和发热,有肺部“暴风雪征”者仅3例。死亡1例,植物人状态2例。结论意识障碍、皮肤粘膜出血点和发热是诊断FES的可靠、主要的诊断指标。随着医疗水平的提高和人们对FES的认识加深,对FES的治愈率明显提高。     

Fat embolism syndrome

The fat embolism syndrome is clinically evident in approximately 0.5-2.0% of patients with long bone fractures. The clinical signs and symptoms are evident in 60% of patients within 24 hours and 85% of patients within 48 hours after trauma. A patient is reported who complained of dyspnea and hemoptysis approximately 72 hours after sustaining a fracture to the distal tibia and fibula. Radionuclide ventilation/perfusion imaging was obtained to rule out pulmonary thromboemboli. Perfusion imaging demonstrated the characteristic diffuse, subsegmental ("mottled") appearance of fatty emboli to the lung.     

多发伤合并脂肪栓塞综合征的临床特点和诊治分析

目的分析多发伤患者脂肪栓塞综合征(FES)的临床特点,总结其诊治经验。方法收集2007年1月～2012年6月我科收治多发伤5 074例患者临床资料,有25例在创伤后继发FES。结合本组患者临床资料,分析其发病特点、诊断和治疗方法。结果 25例均为多发伤,损伤严重程度(ISS)≥16,FES发生率0.49%,脂肪栓塞症状伤后平均43.68h。所有患者给与积极有效的治疗措施,其中治愈12例,明显好转后转当地医院治疗7例,植物状态1例,放弃治疗1例,死亡4例,死亡率为16%。结论在多发伤中,FES发生率低但死亡率高,关键是对FES的早期诊断和及时处理创伤后长骨骨折。选择积极有效的综合治疗,改善创伤后FES患者的预后。     

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.     

低分子右旋糖酐与地塞米松预防脂肪栓塞综合征的实验研究

目的 探讨药物预防脂肪栓塞综合征(FES)的效果与机制.方法 雄性Wistar大鼠80只,随机分成低分子右旋糖酐组(A组)、地塞米松组(B组)、地塞米松与低分子右旋糖酐联用组(C组)及空白对照组(D组),每组20只.均采用油酸静脉注射诱发FES,于药物注射后1、2、3、4小时各取5只大鼠行动脉血氧分压(PaO2)、肺组...     

Early bilateral pulmonary embolism following a moderate blunt chest trauma: A case report

Post-traumatic pulmonary embolism (PE) remains a major problem in cardio-pulmonary diseases and represent the third most common cause of death in trauma patients. Traditional PE occur most commonly between the fifth and the seventh day after a major trauma and are rare before the fourth day. Here, we report a case of acute pulmonary embolism developing 1 day after a moderate thoracic injury in a previously well young man. The diagnosis was made by non-invasive methods and the patient was given anticoagulation therapy with good outcome. The circumstances and the early occurrence of PE in this case is at odds with what is generally reported after trauma.     

股骨干骨折并发脂肪栓塞综合征的诊断与治疗

目的 探讨股骨干骨折后脂肪栓塞综合征（FES）的诊断与治疗方法。方法 1989－1998年收治的股骨干骨折病人212例，对并发FES的8例病人的临床表现、治疗方法与结果进行描述。结果 184例单股骨折病人发生FES4例，28例双股骨骨折病人发生FES4例，发生率分别为2．2％和16．7％，P＜0．05。结论 FES更好发于双股骨骨折病人；骨折的早期开放复位固定可降低FES的发生率，而骨折髓内针固定有增加FES发生的危险；呼吸支持和循环维持是治疗FES的关键，早期大剂量激素应用有肯定的治疗效果。