Kroupa J, Unger K
Research Institute of Traumatology, Brno.
Czech Med. 1988;11(4):217-40.
In the introductory part contemporary data concerning fat embolism occurrence and mortality, as taken from the world literature, are evaluated. Thus, the author opens the whole complicated problem of post-mortem examination findings with a different extent of fat embolization (most often in the lungs, rarely in organs belonging to the area supplied by the systemic blood circulation) on the one hand and the fat embolism clinical syndrome on the other hand. The clinical syndrome is a rare phenomenon in comparison with the relatively frequent morphological abduction findings of a more serious character (of the 2nd and higher degree). The evaluation of fat embolism as the main cause of death cannot be based only on the morphological findings, ascertained at the post-mortem examination in the organs of patients who died of injury consequences. At the same time, however, the question is open of evaluating the fat embolism syndrome as the contrary of the fulminant form of fat embolism to the classical fat embolism syndrome as it manifests itself in practice after the free interval. The author sees the mentioned contrary in the fact that the diagnosis of the fulminant fat embolism syndrome resulting in death within a few hours is mainly based on the microscopical findings of fat embolism in the capillaries of the organs whereas that of the classical fat embolism syndrome is possible not only clinically but can be confirmed also macroscopically and microscopically, morphologically and histologically in the cases of death of such injured patients. The morphological confirmation of the classical fat embolism syndrome after an accidental death within some weeks after the injury and after the clinical course of the classical syndrome has, however, time limits as far as the macroscopical findings but especially the microscopical evidence of fat embolism are concerned. In this part of the study many statements of the author are based on the occurrence of 208 patients with fat embolism in the continuously observed clinical material of all the hospitalized injured persons (16,706) at the Research Institute of Traumatology between 1963-1983. In consideration of the accumulated admission of severely injured patients from traffic accidents especially, the total mortality is 6.55% (6.25% of men; 7.18% of women). Fat embolism as the main cause of death makes up 10.15% (8.25% of men; 13.61% of women) of total mortality. The occurrence of the fat embolism syndrome is, however, much lower: 1.25% (1.16% of men; 1.43% of women). The fat embolism syndrome mortality is high: 53.73% (44.70% of men; 68.42% of women).
在引言部分，作者评估了从世界文献中获取的关于脂肪栓塞发生率和死亡率的当代数据。这样一来，作者一方面提出了尸检结果这一复杂问题，即不同程度的脂肪栓塞（最常见于肺部，很少见于体循环供血区域的器官），另一方面则涉及脂肪栓塞临床综合征。与相对常见的、更为严重的（二级及以上）形态学异常发现相比，临床综合征是一种罕见现象。将脂肪栓塞视为主要死因不能仅基于在因损伤后果死亡患者器官的尸检中确定的形态学发现。然而，与此同时，关于将暴发性脂肪栓塞综合征与经典脂肪栓塞综合征相对比进行评估的问题仍然存在，因为暴发性脂肪栓塞综合征在实际中表现为在短暂间隔后出现，而经典脂肪栓塞综合征在受伤患者死亡的情况下不仅可以通过临床诊断，还能在宏观和微观层面、形态学和组织学上得到证实。然而，对于在损伤后数周意外死亡且经历经典综合征临床过程的患者，经典脂肪栓塞综合征的形态学证实，就宏观发现而言，尤其是脂肪栓塞的微观证据，存在时间限制。在本研究的这一部分，作者的许多陈述基于1963年至1983年期间创伤研究所对所有住院受伤人员（16706人）持续观察的临床资料中208例脂肪栓塞患者的发生情况。考虑到尤其是交通事故中重伤患者的累积收治情况，总死亡率为6.55%（男性为6.25%；女性为7.18%）。脂肪栓塞作为主要死因占总死亡率的10.15%（男性为8.25%；女性为13.61%）。然而，脂肪栓塞综合征的发生率要低得多：1.25%（男性为1.16%；女性为1.43%）。脂肪栓塞综合征的死亡率很高：53.73%（男性为44.70%；女性为68.42%）。
