摘要
目的比较骨折后脂肪栓塞综合征(FES)患者与同期同类型骨折患者(对照组)各时间段肌酶、肌钙蛋白I(Tnl)、D-二聚体(D-dimer)、肺CT的变化,观察各项指标与病情变化之间的联系。方法35例患者根据Gurd提出的诊断标准确诊为FES,其中31例抢救治疗成活,监测发病后≤24h及3、5、7d时肌酶、TnI、血凝分析,与对照组进行对比。检查发病3d内和2周内肺CT。对比各项检查指标变化及其之间的联系。结果与对照组比较,35例FES患者肌酶均升高,31例经抢救治疗成活患者中28例≤24h达高峰,35例TnI、D-dimer、纤维蛋白原(Fib)也均升高;两组患者肌酶、TnI、Fib、D-dimer比较差异有统计学意义。肺CT在急性期呈点片状、絮状、暴风雪样高密度影,随病情好转肌酶、胸部影像、临床症状的好转是同步的。结论骨折后发生FES的患者肌酶、TnI、D-dimer、Fib均比对照组增高,其数值随病情好转下降,与肺部影像吸收好转相一致。测定肌酶、TnI、D-dimer、Fib可为该病诊断、观察治疗效果提供依据。
Objective To explore the changes of muscle enzymes, troponin I ( TnI), D - dimer and lung CT in the patients with fat embolism syndrome (FES) after fracture. Methods Muscle enzyme, TnI, D - dimer and fibrinogen (Fib) were measured at 3,5 and 7 day 'after the onset of FES in 35 patients. Age - matched patients with the same type of fracture were used as control group. All the patients with FES underwent lung CT at 3 days and 2 weeks after the onset of FES. Results Compared with the control group, muscle enzymes were significantly elevated in FES group. In 31 patients who survived, muscle enzyme peaked within 24 h in 28 patients. TnI, D - dimer, Fib were significantly higher in 35 patients than in control group. Lung CT in the acute phase revealed wide spread petechial high- intensity signal. Enzymes decreased and chest imaging changes improved with resolution of clinical symptoms. Conclusion The serum levels of muscle enzymes, TnI, D - dimer and Fib in the patients with FES are higher than those of control group at acute stage and gradually return to normal level as FES improved . Muscle enzymes, TnI and D - dimer might be useful in diagnosing FES and monitoring therapeutic effect.
出处
《中国急救医学》
CAS
CSCD
北大核心
2013年第3期220-224,共5页
Chinese Journal of Critical Care Medicine
基金
河北省科技厅支撑计划项目072761499