急诊脑脂肪栓塞综合征早期诊断和治疗

Early Diagnosis and Treatment of Emergent Cerebral Fat Embolism Syndrome

目的探讨骨折并发脑型脂肪栓塞的诊断、鉴别诊断与治疗。方法回顾分析26例骨折并发脑型脂肪栓塞患者的诊治经过,重点讨论与颅脑外伤的鉴别诊断。患者采用以激素(地塞米松40～80mg/d)为主的综合治疗。结果26例中的23例经5～32d治疗,均完全清醒,生命体征恢复正常。其他3例因呼吸衰竭死亡。结论骨折病人伤后或术后早期突发的非颅脑损伤引起的嗜睡或昏迷,应高度怀疑脑型脂肪栓塞,行头颅MRI检查,尽早确诊,以免延误救治时机。

[ Objective ] To study the diagnosis, differential diagnosis, and the treatment of fracture complicated with cerebral fat embolism syndrome. [ Methods] The clinical data of 26 cases of fracture complicated with cerebral fat embolism syndrome were analyzed retrospectively, especially the differential diagnosis from brain injury were reviewed. All the cases were treated with the compre- hensive treatment mainly composed by hormone therapy （ dexamethasone 40 - 80mg/d）. [ Results ] In all the patients ,23 cases were cured and their vital signs returned to normal ranges in 5 - 32 days ;3 cases died of respiratory failure. [ Conclusion] Sudden somnolence or coma that does not result from brain injury after limb fractures in early stage should be suspected as cerebral fat embolism syndrome. Further examinations such as MRI can help to diagnose so as not to delay the cure time.