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[创伤后血脂异常性凝血病转变为临床脂肪栓塞综合征时预后判断的可能性]

[Possibilities of determining prognosis in the transformation of post-traumatic dyslipidemic coagulopathy into the clinical fat embolism syndrome].

作者信息

Kroupa J, Koha R A, Sluckij L I

机构信息

IMV, Výzkumný ústav traumatologie a speciální chirurgie, Brno.

出版信息

Acta Chir Orthop Traumatol Cech. 1990 Aug;57(5):421-42.

PMID:2275308
Abstract

The clinical and laboratory retrospective and prospective study orientated to the observation of total posttraumatic response of the organisms to serious injuries (fractures of long bones of lower extremities, fractures of bones of pelvis, serious multiple injuries of body cavities associated with fractures) has concentrated hyperglobulaemia and at the same time also of disorders of blood coagulation. These in all three institutes on the verification of the significance of hyperglobulaemia, disorders of blood coagulation and persistent tachycardia. The analysis of the relations between the findings of fat hyperglobulaemia, disorders of coagulation and persistent tachycardia has made it possible to present a thesis which is very important from the practical viewpoint, and namely that the persistent tachycardia in case of in-patients is in fact a clinical reflection or manifestation, an equivalent, even of the incidence of fat studies concentrated on the syndrome of traumatic fat embolism (F. E.) were carried out within a uniform concept of "post-traumatic dyslipidemic coagulopathy - PDC". A statistically significant relation has been proved between the incidence of fat hyperglobulaemia and the incidence of persistent tachycardia. When identifying the relations between individual laboratory and clinical findings the authors have proceeded from a pre-requisite we have objectified before, and namely that fat hyperglobulaemia and disorders in blood coagulation contribute significantly to the development of the syndrome of post-traumatic fat embolism. The origin of persistent tachycardia which is motivated in patients with fractures of bones neither by the increase of temperature nor by any other pathophysiological circumstances, represents a turning point or a time limit between PDC as a latent pathological condition and PDC with clinical manifestations, being associated in the subclinical form only with persistent tachycardia or in the manifest form with other evident symptoms (including persistent tachycardia). It is then possible to use the symptom of an early and persistent tachycardia in the clinical practice for the prognostication of possibilities of unfavourable pathophysiological development of the subclinical form of fat embolism into the clinically manifest form of fat embolism.

摘要

这项临床及实验室回顾性和前瞻性研究旨在观察机体对严重损伤(下肢长骨骨折、骨盆骨折、与骨折相关的体腔严重多发伤)的整体创伤后反应,研究发现了高球蛋白血症以及同时存在的凝血功能障碍。这三个机构均对高球蛋白血症、凝血功能障碍和持续性心动过速的意义进行了验证。对脂肪高球蛋白血症、凝血功能障碍和持续性心动过速的研究结果之间的关系进行分析后,得出了一个从实际角度来看非常重要的论点,即住院患者的持续性心动过速实际上是创伤性脂肪栓塞综合征(F.E.)临床反映或表现的一种等效指标,甚至是其发生率的反映。关于“创伤后血脂异常性凝血病 - PDC”这一统一概念下的脂肪研究集中在创伤性脂肪栓塞综合征。已证明脂肪高球蛋白血症的发生率与持续性心动过速的发生率之间存在统计学上的显著关系。在确定个体实验室和临床研究结果之间的关系时,作者依据了之前已客观化的一个前提,即脂肪高球蛋白血症和凝血功能障碍对创伤后脂肪栓塞综合征的发展有显著影响。骨折患者出现的持续性心动过速,其原因既不是体温升高,也不是任何其他病理生理情况,它代表了作为潜在病理状态的PDC与具有临床表现的PDC之间的一个转折点或时间界限,在亚临床形式中仅与持续性心动过速相关,而在明显形式中与其他明显症状(包括持续性心动过速)相关。因此,在临床实践中,可以利用早期和持续性心动过速这一症状来预测亚临床形式的脂肪栓塞发展为临床明显形式的脂肪栓塞的不良病理生理发展可能性。

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