术中急性肺动脉脂肪栓塞致心搏骤停二例救治体会

Successful Resuscitation of 2 Patients with Cardiac Arrest Caused by Acute Pulmonic Fat Embolisms during Surgical Procedures

目的探讨影响术中肺动脉脂肪栓塞致心搏骤停救治成功的因素。方法对我院收治的术中发生急性肺动脉脂肪栓塞致心搏骤停2例的临床资料进行回顾性分析。结果 2例均为女性,1例行股骨骨折切开复位术,术中突发血压下降、意识丧失、呼吸骤停,即刻予心脏按压、正性肌力药物、电除颤等治疗,救治成功,抢救中见颈部、前胸、腋下有紫斑,查D-二聚体明显升高。1例行下肢、腰臀部和腹部脂肪抽吸术,自体脂肪充填隆胸术及自体脂肪阴道壁充填术,术中突发呼吸、循环衰竭,摄床旁X线胸片示双肺大片模糊影像,符合肺动脉脂肪栓塞表现,颈部、腋下及前胸亦出现紫斑,抢救无效死亡。结论及时有效心脏按压和正性肌力药物应用使阻塞肺动脉再通程度是肺动脉脂肪栓塞抢救成功的决定性因素。

Objective To discuss important factors of successful resuscitation of cardiac arrest caused by suspected acute pulmonie fat embolisms during surgical procedures. Methods Clinical data of 2 patients with acute pulmonic fat embolism during surgical operation in our hospital were retrospectively analyzed. Results The 2 patients were female. One underwent open reduc- tion of fracture of femur, who experienced low blood pressure, unconsciousness and no spontaneously breathing during operation, and was successfully remedied by cardiac compression, eardiotonic agents and electric defibrillation; there were petechias in neck, breast and armpit with higher D-dimeride during first aid. The other patient experienced gusty respiratory and circulatory failure, and large fuzzy image in both lungs by chest X-ray film at bedside which corresponded with fat embolism of pulmonary artery, and petechias in breast and armpit during liposuction in lower extremity, waist-gluteal region, abdomen, autologous fat filling of breast implants and posterior vaginal wall plombage. The patient died after unsuccessful emergency operations. Conclusion Important factors of successful resuscitation of the acute pulmonie fat embolism are pulmonary artery reperfusion and the degree of its reperfu- sion with effective cardiac compression and application of eardiotonic agents.