改良创伤严重度评分与药物在预防骨创伤脂肪栓塞的应用  

Revised injury severity score combined with the drug therapy for prevention of fat embolism syndrome secondary to musculoskeletal trauma

作　　者：覃宇宙 蔡贤华 刘曦明 谭宗奎 钟炎军 QIN Yu-zhou;CAI Xian-hua;LIU Xi-ming;TAN Zong-kui;ZHONG Yan-jun(Wuhan General Hospital of PLA,Wuhan 430065,China)

机构地区：[1]解放军武汉总医院骨科,武汉430065

出　　处：《中国矫形外科杂志》2019年第2期141-144,共4页Orthopedic Journal of China

基　　金：湖北省卫生计生科研基金(编号:WJ2015MA013)

摘　　要：[目的]观察改良创伤严重度评分法(RISS)结合药物预防骨创伤并发脂肪栓塞(FES)的效果。[方法]采用前瞻性研究2016年3月～2017年10月收治的骨创伤患者1305例,根据是否合并胸、腹、颅脑等其他部位的多发损伤和RISS分值,将患者分为四组:A组104例为单纯四肢长管状骨骨折,RISS分值<11分;B组256例为单纯四肢长管状骨骨折,RISS分值≥11分;C组358例为四肢长管状骨骨折同时合并有多发损伤,RISS分值<18分;D组587例为四肢长管状骨骨折同时合并有多发损伤,且RISS分值≥18分。其中A、C两组不给予药物预防措施,B、D两组给予低分子右旋糖酐加地塞米松药物预防,观察FES的预防效果。[结果] 1 305例骨创伤患者中,发生临床FES 3例,男女比例为2:1,平均年龄为(38.32±13.22)岁。A组和C组均无FES发生;B组发生1例FES,RISS分值为13分;D组发生2例FES,其RISS分值分别为21分和25分。各组患者性别、年龄和入院时间差异无统计学意义(P>0.05),各组RISS值比较差异具有统计学意义(P<0.05)。[结论]应用RISS评分法对骨创伤易并发FES患者进行快速筛选并给予药物预防,有肋于降低FES的发病率。[Objective] To explore the outcomes of revised injury severity score(RISS) combined with drug therapy for prevention of fat embolism syndrome(FES) secondary to musculoskeletal trauma. [Methods]A prospective study was conducted on1305 patients who were admitted in our hospital from Mar. 2016 to Oct. 2017 for musculoskeletal trauma. According to whether or not accompanied with multiple injuries, such as chest, abdomen and brain injuries, and RISS, the patients were divided into 4 groups as follows: 104 patients in the group A suffered from simple long bone fractures with RISS<11, while 256 patients in the group B were of simple long bone fractures with RISS≥ 11, additionally 358 patients in the group C suffered from long bone fractures accompanied with multiple injuries and RISS<18, besides 587 patients in the group D were of long bone fractures accompanied with multiple injuries and RISS≥ 18. Of them, the patients in the group A and B did not obtained prophylactic drug therapy, while those in the group C and D received prophylactic administration of rheomacrodex and dexamethasone for FES. The clinical consequences were compared among the 4 groups. [Results] Among the 1 305 patients with musculoskeletal trauma, 3 patients with male and female ratio of 2∶1 and the average age of(38.32±13.22) years were definitively diagnosed of clinical FES. No FES happened in any patients in the group A and C, whereas 1 case of FES with RISS of 13 was in the group B, and other 2 cases of FES with RISS of 21 and 25 respectively were in the group D. Although no significant differences were found among the 4 groups regarding to gender, age and the time elapsed between injury and hospitalization(P>0.05), the RISS were significantly different among them(P>0.05). [Conclusion]The RISS for rapid screening of musculoskeletal trauma and prophylactic drug therapy is helpful to reduce the incidence of FES.

关 键 词：骨创伤 创伤严重度改良评分法 脂肪栓塞综合征 预防 

分 类 号：R687[医药卫生—骨科学]