外科重症监护病房内栓塞症的诊断与治疗——附4例报告及文献复习

Diagnosis and treatment of embolism syndrome in surgical intensive care unit: report of 4 cases

目的分析外科重症监护病房(surgicalintensivecareunit,SICU)内常见栓塞症(脂肪栓塞和羊水栓塞)的临床表现,探讨其诊断和治疗方法。方法对我院2002年SICU确诊的4例栓塞症患者的临床资料进行回顾性分析。结果4例患者中,男1例,女3例,年龄23～36岁。1例为左上肢、双下肢长骨骨折致脂肪栓塞,1例为左股骨骨折致脂肪栓塞,1例为剖宫产术中发生羊水栓塞,1例为催产素引产失败后发生羊水栓塞。4例患者均不同程度出现意识改变、呼吸衰竭、贫血、血小板减少,除1例病情较重死亡,其余均痊愈出院。结论SICU内患者病情复杂,对长骨骨折及高危产妇,要警惕栓塞症的发生,如果早期诊断,及时治疗,预后良好。

Objective To analyze the clinical characteristics, diagnosis and treatment of embolism syudrome, including fat embolism and amniotic fluid embolism in surgical intensive care unit（SICU）. Methods The clinical data of 4 patients with embolism syndrome in our SICU were studied retrospectively. Results The patients＇ age ranged from 23 to 36 years.one case was diagnosed as fat embolism caused by left upper limb and lower lhnbs fracture,and one case was caused by long thighbone fracture. The other two cases suffered from amniotic fluid embolism caused by cesarealr section and drug-induced abortion, respectively.The clinical manifestations of 4 patients prtesented as disturbance of consciousness, respiratory failure, anaemia, and thrombocytopemia. All 4 patients cured with proper treatments, except one death. Conclusion We must pay more attentions to the patients with long bone fracture and high risk gravida in SICU, and beware of embolism syndrome. Early diagnosis and proper treatment in time are very important 1o the good prognosis.