de Lima E Souza Rodrigo, Apgaua Bruno Tavares, Milhomens João Daniel, Albuquerque Francisco Tadeu Motta, Carneiro Luiz Antônio, Mendes Márcio Henrique, Garcia Tiago Carvalho, Paiva Clerisson, Ladeia Felipe, Jeunon Deiler Célio
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil; Associação de Medicina Intensiva Brasileira (AMIB), São Paulo, SP, Brasil.
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
Rev Bras Anestesiol. 2016 May-Jun;66(3):324-8. doi: 10.1016/j.bjan.2013.11.006. Epub 2015 Mar 13.
Fat embolism syndrome (FES) may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe FES after liposuction and fat grafting.
SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45minutes of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO2 = 51mmHg; PO2 = 52mmHg; BE = -8; HCO3 = 18 mEq/L, and lactate = 6.0 mmol/L. Transthoracic echocardiogram showed PASP = 55mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24h of intensive treatment, the patient developed anisocoria and coma (glasgow coma scale = 3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72h of evolution, the patient progressed to brain death.
FES usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis.
脂肪栓塞综合征（FES）可能发生于多发性创伤（长骨骨折）或整形手术（抽脂）患者，会损害循环、呼吸和/或中枢神经系统。本报告展示了抽脂及脂肪移植后严重FES的病情发展。
SSS，42岁，美国麻醉医师协会（ASA）分级为1级，无血栓形成风险因素，拟行腹部抽脂及乳房植入假体手术。采用基础监测和控制通气的平衡全身麻醉。手术进行45分钟后，呼气末二氧化碳分压突然逐渐下降，出现严重低氧血症和低血压。立即对患者进行平均动脉压（MAP）监测并置入中心静脉导管，给予血管升压药、正性肌力药及晶体液输注治疗，使其病情稳定。动脉血样本显示pH = 7.21；二氧化碳分压（PCO2）= 51mmHg；氧分压（PO2）= 52mmHg；碱剩余（BE）= -8；碳酸氢根（HCO3）= 18 mEq/L，乳酸 = 6.0 mmol/L。经胸超声心动图显示肺动脉收缩压（PASP）= 55mmHg，心室舒张功能减退且左心室射血分数（LVEF）= 60%。诊断为肺栓塞。经过24小时的强化治疗，患者出现瞳孔不等大及昏迷（格拉斯哥昏迷量表评分为3分）。进行脑部CT检查，结果显示严重的大脑半球缺血，右侧大脑中动脉有脂肪栓塞迹象；经食管超声心动图显示卵圆孔未闭。最终，经过72小时的病情发展，患者进展为脑死亡。
FES通常发生于年轻人。治疗主要基于液体输注、血管活性药物、机械通气以及触发因素纠正（早期固定骨折或暂停抽脂）。多器官受累提示预后较差。
