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。

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

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.