多发性胸部骨折致肺脂肪栓塞的临床分析及诊治对策

Clinical analysis and strategy of diagnosis and treatment of pulmonary fat embolism caused by multiple fracture of thoracic region

目的探讨多发性胸部骨折所致脂肪栓塞的早期诊断影响因素,并针对临床症状进行治疗。方法对我院收治的13例肺脂肪栓塞患者进行资料回顾,分析其临床表现,对影响早期诊断的因素进行logsitic回归分析,探讨早期诊断的影响因素及治疗策略。结果早期主要以首发呼吸系统症状为主,主要临床表现为低氧血症;中枢神经系统症状主要表现为胡言乱语、昏迷、神志模糊、抽搐等。在影响早期诊断因素中,脑挫伤、肺挫伤对早期肺脂肪栓塞的诊断的影响负相关(P<0.05);中枢神经系统、呼吸系统以及胸部X线、CT对肺脂肪栓塞诊断的影响正相关。结论针对影响脂肪栓塞早期诊断的因素进行提前预防,治疗重点是纠正低氧血症,提高呼吸功能,改善微循环,保护主要脏器功能。

Objective Explore the factors affected the early diagnosis of multiple thoracic fractures caused hy fat embolism. Methods Retrospective clinical data of 13 cases pulmonary fat embolism patients were treated in our hospital, analysis of the clinical manifestation, and used Logsitic regression analysis on Influencing Factors of early diagnosis, explored the factors and treatment strategy of early diagnosis. Results Early symptoms mian in respiratory symptoms, the main clinical manifestations were hypoxemia. Central nervous system symptoms mainly in talk rubbish, coma, convulsions, consciousness is ambiguous（P 〈 0. 05 ）. Effects of brain contusion, pulmonary contusion in early diagnosis of pulmonary fat embolism negative correlation ,affect the central nervous system, respiratory system and chest X-ray, CT of pulmonary fat embolism diagnosis positive correlation. Conclusion Early prevention and influence factors on early diagnosis of fat embolism,the key point of treatment is to correct hypoxemia, improve respiratory function, improve microcirculation, protect the function of major organs.