骨折后脂肪栓塞综合征患者肌酶肌钙蛋白ID-二聚体肺CT变化  

Changes of muscle enzymes, troponin I, D - dimer, lung CT in the patients with fat embolism syndrome after fracture

作　　者：李亚华[1] 陈刚[1] 郝建东[2] 赵瑞贞[1] 董运芳[1] 卢炜[1] 

机构地区：[1]河北医科大学第三医院呼吸科,河北石家庄050051 [2]河北医科大学第三医院创伤骨科,河北石家庄050051

出　　处：《中国急救医学》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

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.

关 键 词：脂肪栓塞综合征(FES) 肌酶 肌钙蛋白I(TnI) D-二聚体(D-dimer) 肺CT 

分 类 号：R683[医药卫生—骨科学]