Habashi Nader M, Andrews Penny L, Scalea Thomas M
Multi-Trauma Critical Care, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, USA.
Injury. 2006 Oct;37 Suppl 4:S68-73. doi: 10.1016/j.injury.2006.08.042.
Signs and symptoms of clinical fat embolism syndrome (FES) usually begin within 24-48 hours after trauma. The classic triad involves pulmonary changes, cerebral dysfunction, and petechial rash. Clinical diagnosis is key because laboratory and radiographic diagnosis is not specific and can be inconsistent. The duration of FES is difficult to predict because it is often subclinical or may be overshadowed by other illnesses or injuries. Medical care is prophylactic or supportive, including early fixation and general ICU management to ensure adequate oxygenation and ventilation, hemodynamic stability, prophylaxis of deep venous thrombosis, stress-related gastrointestinal bleeding, and nutrition. Studies support early fracture fixation as a method to reduce recurrent fat embolism and FES. The main therapeutic interventions once FES has been clinically diagnosed are directed towards support of pulmonary and neurological manifestations and management of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS).
临床脂肪栓塞综合征（FES）的体征和症状通常在创伤后24 - 48小时内出现。典型的三联征包括肺部改变、脑功能障碍和瘀点皮疹。临床诊断至关重要，因为实验室和影像学诊断不具有特异性且可能不一致。FES的病程难以预测，因为它通常是亚临床的，或者可能被其他疾病或损伤所掩盖。医疗护理为预防性或支持性的，包括早期固定和普通重症监护病房管理，以确保充分的氧合和通气、血流动力学稳定、预防深静脉血栓形成、应激相关的胃肠道出血以及营养支持。研究支持早期骨折固定作为减少复发性脂肪栓塞和FES的一种方法。一旦临床诊断为FES，主要的治疗干预措施是针对肺部和神经症状的支持以及急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）的管理。
