Woolrich F S, Hernández C T, Chiñas A V, Fajardo L M, Rojas O S, Alonso A F, de la Peña Sandoval J
Arch Inst Cardiol Mex. 1975 May-Jun;45(3):326-34.
An analys is made of the frequency of fat-embolism in patients with battle wounds and in those who suffer traumatisms in every day life; it was found in a high percentage in both groups. It is noted that when tye symptom appear little after the traumatism, the percentage of death is higher (85%) than when they appear within 24 to 72 hours later (10-20%). During 5 year, in the Hospital Central Militar de Mexico 12 cases of fat-embolism have been diagnosed. The first ten were handled by the classic method: ventilatory assistance, corticoids, heparin, etc.; having 30% of deaths. The two last ones were treated by ligation of the inferior vena cava; none of the two died and there was a remarkable change in the course of the clinical manifestations. Based on the experience of the group, in more than 120 cases with ligation of the inferior vena cava due to pulmonary thromboembolism; there was a symptomatic paralelism found between the fat-embolia and the repeated venous embolism; and in our opinion we conclude that the progressiveness of the respiratory insufficiency is due to repeated fat-emboly more so than to the convertion of neutral fat into fatty acids through the action of lipasa in various tissues. With this hypothesis the inferior vena cava was ligated in two patients, and the results obtained were the ones mentioned before. It is emphasized that the procedure has a very low risk of death and there are minimum sequels, more in relationship to the previous flebitic state, than to the ligation itself. It is indicated that the corticosteroids, heparin, ventilatory and cardiac assistance be continued, besides elastic bandage, elevation of the pelvic limbs, exercises, etc. It is accepted that two cases cannot be enough to fully demonstrate how good the method is, but the changes of progress of these two cases after the ligation were so notable, that we are able to recommend this method in all those patients with an important fat-embolism. It is indicated that in the laboratory of Experimental Surgery of the H.C.M. experiments are being made to demonstrate what has been obtained clinically.
分析了战伤患者和日常生活中遭受创伤者脂肪栓塞的发生率；发现两组中该发生率均很高。值得注意的是，创伤后症状出现较晚时，死亡率（85%）高于在创伤后24至72小时内出现症状时（10 - 20%）。在5年期间，墨西哥中央军事医院诊断出12例脂肪栓塞病例。前十例采用经典方法治疗：通气辅助、使用皮质类固醇、肝素等；死亡率为30%。最后两例采用下腔静脉结扎术治疗；两例均未死亡，临床表现过程有显著变化。根据该组经验，在120多例因肺血栓栓塞而行下腔静脉结扎术的病例中；发现脂肪栓塞与反复静脉栓塞之间存在症状上的平行关系；我们认为，呼吸功能不全的进展性更多是由于反复脂肪栓塞，而非通过各种组织中脂肪酶的作用将中性脂肪转化为脂肪酸。基于这一假设，对两名患者进行了下腔静脉结扎术，得到了上述结果。强调该手术死亡风险极低，后遗症最少，更多与先前的静脉炎状态有关，而非结扎本身。表明除使用弹性绷带、抬高下肢、进行锻炼等外，应继续使用皮质类固醇、肝素、通气和心脏辅助治疗。公认两例病例不足以充分证明该方法有多好，但这两例病例结扎后病情进展的变化非常显著，以至于我们能够向所有患有严重脂肪栓塞的患者推荐该方法。表明在墨西哥中央军事医院实验外科实验室正在进行实验，以证实临床所取得的成果。
