脂肪栓塞综合征的诊治体会及文献复习

发布时间：2018-05-09 03:29

本文选题：脂肪栓塞综合征 + 诊断　；参考：《重庆医科大学》2015年硕士论文

【摘要】：背景：脂肪栓塞综合征(fat embolism syndrome,FES)是由多种原因导致来自骨髓和或其他组织的脂肪、脂类物质进入血液,或在血管内形成游离脂肪酸,进而栓塞肺、脑、皮肤等组织或器官,导致以呼吸困难、中枢神经系统功能障碍、皮肤瘀斑为“三联征”的一类临床综合征。其起病快,进展迅速,临床表现复杂,早期极易误诊或漏诊,延误病情,影响预后。目的：探讨脂肪栓塞综合征的临床特征及诊治效果,并行文献复习。方法：回顾性分析11例脂肪栓塞综合征患者的病因、首发起病形式、实验室和影像学特征、治疗及预后。结果：11例患者中,创伤后长骨骨折9例,膝关节人工置换术后2例。首发意识障碍10例,呼吸困难1例,皮肤瘀点3例,胸片“爆风雪”征2例,肺CT异常8例,MRI显示多发脑梗死3例。72小时内确诊率63.63%,误诊率36.36%。7人治愈,1人植物状态,3人死亡,死亡率27.2%。结论：FES的病因多为创伤性长骨骨折或关节手术,临床表现形式复杂,早期极易误诊。治疗成功的关键是早期确诊并给与有效的综合治疗。
[Abstract]:Background: fat embolism syndrome (FES) is caused by a variety of causes from bone marrow and other tissues of fat, lipids enter the blood, or form free fatty acids in the blood, and then embolize the lung, brain, skin and other tissues or organs. Dyspnea, central nervous system dysfunction and skin ecchymosis are a kind of syndromes. Its clinical manifestation is complicated, it is easy to misdiagnose or miss diagnosis early, delay the condition and affect the prognosis. Objective: to investigate the clinical features, diagnosis and treatment of fat embolism syndrome and review the literature. Methods: the etiology, initial onset, laboratory and imaging features, treatment and prognosis of 11 patients with fat embolism syndrome were retrospectively analyzed. Results among 11 cases, 9 cases had long bone fracture after trauma and 2 cases had knee arthroplasty. There were 10 cases of initial disturbance of consciousness, 1 case of dyspnea, 3 cases of skin stasis, 2 cases of "blizzard" sign on chest film, 8 cases of abnormal lung CT in 3 cases with multiple cerebral infarction within 72 hours. The diagnosis rate was 63.63 3%, and the misdiagnosis rate was 36.36.7 people cured and 1 person died in vegetative state. The mortality rate was 27.2%. Conclusion the etiology of FES is traumatic long bone fracture or joint surgery. The key to successful treatment is early diagnosis and effective combination therapy.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589.2

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