Sarmiento Penide A, Rodríguez Velasco A, López Pérez M, Rama-Maceiras P, Molíns Gauna N, Rey Rilo T, Acción Barral M
Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario Juan Canalejo, A Coruña.
Rev Esp Anestesiol Reanim. 2004 May;51(5):276-80.
A 66-year-old woman developed hemodynamic instability, oliguria, prostration, fever, and coagulopathy 4 hours after surgery to replace the femoral stem component of a hip prosthesis under a combined subarachnoid-epidural block. Dyspnea and tachypnea developed, and a petechial rash appeared 24 hours later. The diagnosis was fat embolism after other possible causes were ruled out. Supplementary oxygen, fluid replacement therapy, and inotropic support were started. The patient's condition improved and she was discharged from the postoperative recovery unit 5 days after admission. Although fat embolism usually appears in young men after large bone fractures, it should be considered when symptoms consistent with this diagnosis arise in patients who have undergone orthopedic surgery so that appropriate treatment can be started early.
一名66岁女性在蛛网膜下腔-硬膜外联合阻滞下进行髋关节假体股骨柄部件置换手术后4小时出现血流动力学不稳定、少尿、虚脱、发热和凝血病。24小时后出现呼吸困难和呼吸急促，并出现瘀点皮疹。在排除其他可能原因后，诊断为脂肪栓塞。开始给予补充氧气、液体替代疗法和强心支持。患者病情好转，入院5天后从术后恢复病房出院。尽管脂肪栓塞通常发生在年轻男性的大骨折后，但在接受骨科手术的患者出现符合该诊断的症状时，应予以考虑，以便尽早开始适当治疗。
