脂肪栓塞综合征5例的早期观察与护理

目的：讨论脂肪栓塞综合征（Fat Embolism Syndrom,FES）早期观察与护理。方法：自2004／2007年,收治5例脂肪栓塞综合征,以呼吸系统和神经系统症状为主要表现,根据脂肪栓塞综合征的临床特征、早期观察、及早发现、及时护理、及时治疗。对已发生者采取积极措施进行治疗,加强护理。结果：本组经过1周治疗后,病情控制,两肺病灶吸收,约2周恢复正常。结论：严重骨折的患者,如出现无明原因的呼吸系统症状或（和）神经症状,应考虑合并脂肪栓塞综合征的发生。对于脂肪栓塞患者的早期观察与护理是非常重要的。     

急性筋膜间隔综合症与胫骨骨折

目的：探讨脂肪栓塞综合征早期诊断指标，提高临床治愈率。方法：通过观察56例患者的症状、体征及相关辅助检查，确立该征的早期诊断指标。结果：脂肪栓塞综合征的典型三联征、血氧分压下降或血氧饱和度、血红蛋白减少、头部MRI T2加权像可作为早期诊断指标。结论：脂肪栓塞综合征只有早期诊断才能提高治愈率。     

脂肪栓塞综合征的早期诊断与治疗

目的探讨脂肪栓塞综合征(FES)的早期诊断与治疗。方法回顾性分析12例脂肪栓塞综合征患者,比较早期主要的临床表现和治疗方法。结果治愈9例,死亡1例,植物人状态1例。12例早期临床症状均表现为低氧血症。结论低氧血症是FES的最主要的早期临床表现,FES的治疗主要是以纠正低氧血症和大剂量激素应用为主的综合治疗。     

创伤骨折后脂肪栓塞综合征的早期监测与护理

目的：探讨创伤骨折后脂肪栓塞综合征的早期监测与护理措施。方法：通过对我科收治的27例创伤骨折引起脂肪栓塞综合征患者进行回顾性分析，早期给予症状观察、体征检查、实验室检查及影像学检查，实行分期护理。结果：所有患者均得到随访，治愈25例，死亡2例。结论：创伤骨折后脂肪栓塞综合征患者的早期监测与护理至关重要，可明显降低致残率及死亡率。     

创伤骨折后脂肪栓塞综合征16例早期诊治分析

目的：探讨创伤骨折后脂肪栓塞综合征的发病机制、早期诊断和治疗措施。方法：回顾分析2001—01／2007—03我科收治的骨折后合并脂肪栓塞综合征患者的临床资料。结果：全部患者均有不同程度的呼吸困难和意识障碍，本组治愈15例，其中1例因呼吸衰竭死亡，随访1．5～2a，无明显后遗症。结论：脂肪栓塞综合征的早期诊断和治疗至关重要，呼吸支持是治疗关键，可以明显降低致残率和死亡率。     

脂肪栓塞综合征17例早期诊治分析

目的：研究脂肪栓塞综合征的早期诊断及治疗。方法：自1998～2007年通过对17例骨折后合并脂肪栓塞患者的早期诊断及治疗，比较其疗效。结果：所有患者术后都予以随访，治愈15例，死亡2例。结论：早诊断及早治疗对积极救治骨折后脂肪栓塞综合征很重要。     

长管骨骨折术后急性脂肪栓塞的预见性护理

目的探讨脂肪栓塞综合征的预防和护理。方法回顾分析我院10例脂肪栓塞综合征的早期观察、护理和诊治经过,总结和分析脂肪栓塞综合征早期临床表现与护理体会。结果本组10例脂肪栓塞综合征患者均有明显的呼吸困难,3例患者出现嗜睡,1例昏迷、大小便失禁,其余6例无明显意识障碍。2例病人出现颈部、前胸的皮肤出血点。10例患者均不同程度出现体温的上升。术后出现症状的时间为24～72h,最早6h平均36h。经正规治疗,10例患者均治愈出院。结论早期及时观察发现患者的呼吸困难、皮肤出血点、血压和体温的改变、神经系统的症状等是脂肪栓塞综合征患者能得到早期诊断和成功抢救的的关键。     

创伤后脂肪栓塞综合征的临床监测与护理体会

目的：总结创伤后脂肪栓塞综合征的临床监测与护理体会。方法：回顾性分析我科2001年5月至2006年5月收治的创伤后脂肪栓塞综合征患者32例的临床资料。结果：30例抢救成功，2例死亡。结论：对创伤后脂肪栓塞综合征病人进行临床监测和综合护理是保证治疗成功的重要措施。     

脂肪栓塞综合征的早期诊断与治疗

脂肪栓塞综合征是重症创伤，特别是多发骨折的严重并发症，其临床表现差异很大，早期症状和体征多不典型，暴发型病例诊断更困难，容易延误诊断而失去治疗时机。笔者于1994～2002年间治疗骨折合并脂肪栓塞综合征12例，分析临床特点，讨论本并发症的早期诊断与治疗。     

多处骨折并发脂肪栓塞病人的临床观察与护理

为提高护理人员对脂肪栓塞综合征的认识及救治效果，回顾性在分析了2000年3月至2003年12月间收入我院6例脂肪栓塞患者的临床观察及护理。结果6例患者均治愈。提示早期发现、早期诊断，合理治疗及护理，能取得良好的效果。     

脂肪栓塞综合征的肺部影像学

目的：探讨脂肪栓塞综合征(FES)的肺部影像学特点。材料与方法：回顾性分析临床证实的10例FES，其中行肺部影像检查者6例，全部6例作过胸部x线摄片，5例经CT扫描。结果：胸部x线摄片的6例中，3例两侧肺纹理增粗或散在斑片状影，1例双肺野弥漫病灶，2例无异常发现：CT检查的5例，均显示多灶性实变、磨玻璃影、结节及坠积现象。结论：影像学检查可为FES的肺部改变诊断提供直接的证据，疑有肺部FES者应尽早行胸部CT检查。     

脂肪栓塞综合征在严重创伤患者延迟诊断的临床分析

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5074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。     

Fat embolism syndrome: prospective evaluation in 92 fracture patients

Hypoxemia following long bone or pelvic fracture (LBPF) is often attributed to fat embolism syndrome (FES), but the true incidence and etiology of postfracture pulmonary shunt (Qsp) are not well defined. Over 12 months, 92 patients with LBPF admitted to a Level I trauma center were prospectively evaluated. Arterial blood gases, Hct, platelet count, serum fibrinogen, serum lipase, and urinary fat bodies (UFB) were determined serially from admission through the fifth hospital day. Patients were evaluated daily by chest x-ray, vital signs, mental status, and presence of petechiae. Four patient groups were established: No Qsp, Qsp with pulmonary injury (Qsp + PI), Qsp without pulmonary injury or petechaie (FES - P), and Qsp without pulmonary injury and with petechiae (FES + P). Qsp indicated by an alveolar/arterial PO2 gradient greater than 100 torr developed in 49 (53%) of the patients. Pulmonary injury was present in 39 (81%) of those 49 and was at least partially responsible for the shunt. The remaining ten patients were diagnosed as having FES; four had petechiae (FES + P) and six were without petechiae (FES - P). The minimum incidence of FES in LBPF is therefore 11%.     

Early diagnosis of fat embolism syndrome by automated image analysis of alveolar macrophages

To evaluate the value of automated semiquantitative analysis of fat within alveolar macrophages as an early diag-nostic tool for fat embolism syndrome (FES), we investigated 3 patients with respiratory failure following long-bone frac-tures. The mean area of fat droplets per alveolar macrophage was determined in pixels and, additionally, the percentage of the evaluated areas was calculated. In 2 patients, the diagnosis of FES could be established as early as 24 hr after trauma. Both patients showed an increase in the area of fat per alveolar macrophage (pixels: 851, 1069) as well as in the percentage of fat area per alveolar macrophage area (40.04%, 52.73%), whereas the analysis of the bronchoalveolar lavage (BAL) specimens of a third patient, who later recovered without ap-pearance of clinical signs of FES, revealed only minimal fat content (pixels: 82; 3.82%). Automated semiquantitative anal-ysis of fat within alveolar macrophages may be helpful in the early diagnosis of FES.     

Postoperative complications of concomitant fat embolism syndrome,pulmonary embolism and tympanic membrane perforation after tibiofibular fracture: A case report

BACKGROUNDFat embolism syndrome (FES) is a rare disease characterized by pulmonary distress, neurologic symptoms, and petechial rash and seriously threatens human life and health. It is still neglected clinically because of the lack of verifiable diagnostic criteria and atypical clinical symptoms. No studies on FES with pulmonary embolism (PE) and tympanic membrane perforation have been reported to date. Here, we report a rare case of concomitant FES, PE and tympanic membrane perforation after surgery in a patient with a tibiofibular fracture.CASE SUMMARYA 39-year-old man presented with right lower extremity pain due to a car accident while driving a motorbike on the road. X-ray and computed tomography scans revealed a fracture of the right mid-shaft tibia and proximal fibula categorized as a type A2 fracture according to the AO classification. A successful minimally invasive operation was performed 3 d after the injury. Postoperatively, the patient developed sudden symptoms of respiratory distress and hearing loss. Early diagnosis was made, and supportive treatments were used at the early stage of FES. Seven days after surgery, he presented a clear recovery from respiratory symptoms. The outcome of fracture healing was excellent, and his hearing of the left ear was mildly impaired at the last follow-up of 4 mo.CONCLUSIONConcomitant FES, PE and tympanic membrane perforation are very rare but represent potentially fatal complications of trauma or orthopedic surgery and present with predominantly pulmonary symptoms. Early diagnosis and treatment can reduce the mortality of FES, and prevention is better than a cure.     

山莨菪碱对脂肪栓塞综合征的防治作用

目的探讨山莨菪碱对脂肪栓塞综合征(FES)的防治作用及其机制。方法实验动物随机分成对照组和用药组，两组采用油酸静脉注射诱发FES，用药组接受山莨菪碱治疗。观察其丙二醛、血浆纤维连接蛋白、动脉血氧分压及病理改变。结果栓塞后对照组的丙二醛明显升高，血浆纤维连接蛋白和动脉血氧分压显著下降；用药组的丙二醛无明显升高，血浆纤维连接蛋白在24、48h，PaO2在12、24、48h的时候显著高于对照组，病理改变也明显减轻。结论氧自由基损伤和血浆纤维连接蛋白持续减少与FES的发生有关，山莨菪碱对FES有一定的防治作用，其作用机制与对抗氧自由基损伤和抑制血浆纤维连接蛋白减少有关。     

浅析脂肪栓塞综合征的诊治

目的探讨脂肪栓塞综合征（FES）的诊断和治疗要点。方法对11例脂肪栓塞综合征病例的诊断、治疗过程进行回顾分析。结果本组11例患者,死亡1例,其余10例临床治愈,未发现后遗症。结论对脂肪栓塞综合征（FES）的诊断和治疗贵在早,休克防治、骨折处理、糖皮质激素应用、高压氧治疗和呼吸支持疗法都非常关键。     

外固定架在严重多发伤并股骨干骨折中的应用

目的　探讨早期外固定架固定股骨干骨折对严重多发伤患者预后的影响。方法　采用回顾性对比分析 ,将 85例严重多发伤 (ISS >2 5 )患者分为两组 :A组床旁局麻下行外固定支架固定股骨干骨折 ;B组行下肢皮牵引或小夹板固定股骨干骨折。将两组患者 4周内的急性呼吸窘迫综合征 (ARDS)、脂肪栓塞综合征 (FES)、多器官功能障碍综合征 (MOSF)发生情况及病死率进行比较。结果　经统计学处理 ,两组的并发症 (ARDS、MOSF、FES)发生率及病死率差异有显著性 ,行外固定架治疗组低于行下肢牵引或小夹板固定治疗组 (P <0 0 5 )。结论　并股骨干骨折严重多发伤患者早期行外固定架固定股骨 ,在降低病死率、减少并发症发生率方面具有良好效果     

激素治疗多发骨折后脂肪栓塞病例分析及文献复习

目的:评价激素治疗脂肪栓塞综合征的益处和副作用。方法和结果:检索Medline、EMBase、及CNKI数据库,共找到7个关于激素预防多发骨折后脂肪栓塞的临床试验,其中5个为随机对照试验(RCT),Meta分析结果发现激素能明显降低脂肪栓塞的发生率[RR=0.15,95%CI(0.06,0.41)]。1994年到2005年6月CNKI数据库一共发表282个激素治疗脂肪栓塞的案例分析,包括2132例患者。激素治疗明显降低死亡和后遗症发生率,增加治愈率,但治疗剂量参差不齐。结论:激素可以有效预防和治疗脂肪栓塞,100～300mg小剂量氢化可的松能有效治疗多发骨折后的脂肪栓塞。而临床医生倾向于使用大剂量。     

Clinical and pathological features of fat embolism with acute respiratory distress syndrome

FES (fat embolism syndrome) is a clinical problem, and, although ARDS (acute respiratory distress syndrome) has been considered as a serious complication of FES, the pathogenesis of ARDS associated with FES remains unclear. In the present study, we investigated the clinical manifestations, and biochemical and pathophysiological changes, in subjects associated with FES and ARDS, to elucidate the possible mechanisms involved in this disorder. A total of eight patients with FES were studied, and arterial blood pH, PaO(2) (arterial partial pressure of O(2)), PaCO(2) (arterial partial pressure of CO(2)), biochemical and pathophysiological data were obtained. These subjects suffered from crash injuries and developed FES associated with ARDS, and each died within 2 h after admission. In the subjects, chest radiography revealed that the lungs were clear on admission, and pulmonary infiltration was observed within 2 h of admission. Arterial blood pH and PaO(2) declined, whereas PaCO(2) increased. Plasma PLA(2) (phospholipase A(2)), nitrate/nitrite, methylguanidine, TNF-alpha (tumour necrosis factor-alpha), IL-1beta (interleukin-1beta) and IL-10 (interleukin-10) were significantly elevated. Pathological examinations revealed alveolar oedema and haemorrhage with multiple fat droplet depositions and fibrin thrombi. Fat droplets were also found in the arterioles and/or capillaries in the lung, kidney and brain. Immunohistochemical staining identified iNOS (inducible nitric oxide synthase) in alveolar macrophages. In conclusion, our clinical analysis suggests that PLA(2), NO, free radicals and pro-inflammatory cytokines are involved in the pathogenesis of ARDS associated with FES. The major source of NO is the alveolar macrophages.