创伤并脑型脂肪栓塞临床分析

Clinical Analysis of Cerebral Fat Embolism Complication After Trauma

目的:探讨并发于创伤、骨折的脑型脂肪栓塞的诊断、鉴别诊断和治疗。方法:回顾性分析9例创伤、骨折并发的脑型脂肪栓塞的治疗经过,股骨干骨折5例,胫腓骨骨折3例,脊柱骨折并骨盆骨折1例。均无颅脑外伤,于伤后10h～3d出现嗜睡和浅昏迷,1例出现间歇性烦躁,并伴有体温升高(38.2～39.5℃),呼吸、心率加快,贫血,胸部有散在出血点。重点讨论与颅脑外伤的鉴别诊断。治疗采取以激素(地塞米松60mg/d)为主的综合治疗。结果:1例死亡,8例经3d～28d的治疗,均完全清醒,生命体征恢复正常。结论:对于创伤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,间歇性烦躁,应高度怀疑脑型脂肪栓塞,与脑外伤颅内出血等鉴别后,应尽早采用以大剂量地塞米松60mg/d为主的综合治疗,疗效满意。

Objective To study cerebral fat embolism complication after trauma and fracture. Methods We review the therapeutic cause of 9 patients with cerebral fat embolism complication after trauma and fracture. 5 patients with femur fracture,3 patients with tibia and fibula fracture and 1 patient with vortebral column and the pelvic girdle fracture,all of them without brain injury. They appeared lethargy and slightly coma from 10 hours to 3 days after trauma. One was intermittent agitated , his temperature was 38.2-39. 5℃ and had deep respiratory and faster heart rate, anemia , hemorrhage spot on his chest. We treated them with dexamethasone (60g/d) ,Results One patient dcad, eight patients recovery. Discuss It is necessary that distinguish cerebral fat embolism after trauma and fracture from cerebral hemorrhage after brain damage. It is important that treat these patients with dexamethasone eatly