骨折并发脑型脂肪栓塞临床报告  

Clinical report of fracture complicated with brain-type fat embolism syndrome

作　　者：傅廷友 蓝朝晖 

机构地区：[1]解放军四一医院骨二科,山东省青岛市266071

出　　处：《中华创伤骨科杂志》2002年第1期37-38,共2页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨并发于骨折的脑型脂肪栓塞的诊断、鉴别诊断和治疗。方法回顾性分析了7例骨折并发的脑型脂肪栓塞的诊治经过,股骨干骨折3例,胫腓骨骨折3例,四肢多发骨折1例,均无颅脑外伤,于伤后9h～3d内出现嗜睡或浅昏迷,并伴有体温升高(37.7～39°C),呼吸、心率加快,贫血,胸部有少许散在的出血点。重点讨论与颅脑外伤的鉴别诊断。治疗方法采取以激素(地塞米松20mg～80mg/d)为主的综合治疗。结果7例经1d～7d的治疗,均完全清醒,生命体征恢复正常。结论对于四肢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,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(地塞米松40mg～80mg/d)为主的综合治疗,疗效满意。Objective To study on diagnosis and treatment of brain type fat embolism syndrome complicated with fracture. Method The diagnosis and treatment of 7 cases of brain type fat embolism syndrome complicated with fracture were reviewed. All of 7 cases did not have any brain injury, 3 cases were complicated with femural fracture, 3 cases with fractures of tibia and fibula, and 1 cases with limbs multi fracture. They presented somnolence or coma complicated with rise in temperature (37.7℃～39℃) ,increase in breath and heart rate,anemia,small bleeding spots at chest. It was discussed how to distinguish brain type fat embolism syndrome from brain injury. Synthetical measure was adopted mainly using dexamethasone (20～80mg/d). Results 7 cases of brain type fat embolism syndrome complicated with fracture were cured in 1～7 days. Conclusions Sudden somnolence or coma that does not result from brain injure after limb fracturees in early stage can be diagnosed as brain type fat embolism syndrome. A synthetical measure should be adopted by mainly using dexamethasone (40～80mg/d) .

关 键 词：脑型脂肪栓塞 骨折 并发症 鉴别诊断 治疗 临床表现 

分 类 号：R683.4[医药卫生—骨科学]