Eriksson Evert Austin, Pellegrini Daniela C, Vanderkolk Wayne E, Minshall Christian T, Fakhry Samir M, Cohle Stephen D
Department of Surgery, Medical University of South Carolina, Charleston, South Carolina 29425, USA.
J Trauma. 2011 Aug;71(2):312-5. doi: 10.1097/TA.0b013e3182208280.
To determine the incidence, time course, and severity of pulmonary fat embolism (PFE) and cerebral fat embolism (CFE) in trauma and nontrauma patients at the time of autopsy.
Prospectively, consecutive patients presenting for autopsy were evaluated for evidence pulmonary and brain fat embolism. The lung sections were obtained from the upper and lower lobe of the patients' lungs on the right and left and brain tissue. This tissue was prepared with osmium tetroxide for histologic evaluation. The number of fat droplets per high power field was counted for all sections. The autopsy reports and medical records were used to determine cause of death, time to death, injuries, if cardiopulmonary resuscitation (CPR) was attempted, sex, height, weight, and age.
Fifty decedents were evaluated for PFE and CFE. The average age was 45.8 years ± 17.4 years, average body mass index was 30.1 kg/cm² ± 7.0 kg/cm², and 68% of the patients were men. The cause of death was determined to be trauma in 68% (34/50) of decedents, with 88% (30/34) blunt and 12% (4/34) penetrating. CPR was performed on 30% (15/50), and PFE was present in 76% (38/50) of all patients. Subjects with PFE had no difference with respect to sex, trauma, mechanism of injury, CPR, external contusions, fractures, head, spine, chest, abdominal, pelvic, and extremity injuries. However, subjects without PFE had significantly increased weight (109 ± 29 kg vs. 86 ± 18 kg; p = 0.023) but no difference in height or body mass index. PFE was present in 82% (28/34) of trauma patents and 63% (10/16) nontrauma patients. Eighty-eight percent of nontrauma patients and 86% of trauma patients who received CPR had PFE. Trauma patients with PFE showed no significant difference in any group. Eighty-eight percent of trauma patients died within 1 hour of injury, and 80% (24/30) of them had PFE at the time of autopsy. CFE was present only in one patient with a severe head and cervical spine injury.
PFE is common in trauma patients. CPR is associated with a high incidence of PFE regardless of cause of death. PFE occurs acutely within the "golden hour" and should be considered in traumatically injured patients. Further studies are needed to evaluate the pathogenesis of PFE.
确定创伤患者和非创伤患者尸检时肺脂肪栓塞（PFE）和脑脂肪栓塞（CFE）的发生率、病程及严重程度。
前瞻性地对连续进行尸检的患者进行肺和脑脂肪栓塞证据评估。从患者左右肺的上叶和下叶以及脑组织获取肺组织切片。该组织用四氧化锇处理以进行组织学评估。对所有切片在高倍视野下计数脂肪滴数量。利用尸检报告和病历确定死亡原因、死亡时间、损伤情况、是否尝试进行心肺复苏（CPR）、性别、身高、体重和年龄。
对50例死者进行了PFE和CFE评估。平均年龄为45.8岁±17.4岁，平均体重指数为30.1kg/cm²±7.0kg/cm²，68%的患者为男性。68%（34/50）的死者死亡原因确定为创伤，其中钝器伤占88%（30/34），穿透伤占12%（4/34）。30%（15/50）的患者进行了CPR，所有患者中76%（38/50）存在PFE。有PFE的患者在性别、创伤、损伤机制、CPR、外部挫伤、骨折、头部、脊柱、胸部、腹部、骨盆和四肢损伤方面无差异。然而，无PFE的患者体重显著增加（109±29kg对86±18kg；p = 0.023），但身高和体重指数无差异。创伤患者中82%（28/34）存在PFE，非创伤患者中63%（10/16）存在PFE。接受CPR的非创伤患者中有88%、创伤患者中有86%存在PFE。有PFE的创伤患者在任何组中均无显著差异。88%的创伤患者在受伤后1小时内死亡，其中80%（24/30）在尸检时存在PFE。仅1例严重头部和颈椎损伤患者存在CFE。
PFE在创伤患者中很常见。无论死亡原因如何，CPR与PFE的高发生率相关。PFE在“黄金小时”内急性发生，创伤患者应予以考虑。需要进一步研究评估PFE的发病机制。
