心肺复苏后非幸存者的肺脂肪栓塞。

Pulmonary fat embolism in non-survivors after cardiopulmonary resuscitation.

机构信息

Department of Forensic Medicine, University Hospital Ostrava, 17.listopadu 1790, Ostrava 708 52, Czech Republic.

Department of Pathology, University Hospital Ostrava, 17.listopadu 1790, Ostrava 708 52, Czech Republic.

出版信息

Forensic Sci Int. 2024 Apr;357:112002. doi: 10.1016/j.forsciint.2024.112002. Epub 2024 Mar 18.

DOI:10.1016/j.forsciint.2024.112002

PMID:38518569

Abstract

BACKGROUND

Blunt trauma acting against the human body presents the fundamental cause of pulmonary fat embolism (PFE) and fat embolism syndrome. The aim of the present study was to investigate PFE in non-survivors after cardiopulmonary resuscitation (CPR).

METHODS

This was a prospective cohort study conducted in University Hospital Ostrava, Czech Republic. Within a 4-year study period, all non-survivors after CPR because of out-of-hospital cardiac arrest were assessed for the study eligibility. The presence/seriousness of PFE was determined by microscopic examination of cryo-sections of lung tissue (staining with Oil Red O).

RESULTS

In total, 106 persons after unsuccessful CPR were enrolled in the study. The most frequent cause of death in the study population (63.2% of cases) was cardiac disease (ischemic heart disease); PFE was not determined as the cause of death in any of our study cases. Sternal fractures were identified 66.9%, rib fractures (usually multiple) in 80.2% of study cases; the median number of rib fractures was 10.2 fractures per person. Serious intra-thoracic injuries were found in 34.9% of cases. Microscopic examination of lung cryo-sections revealed PFE in 40 (37.7%) study cases; PFE was most frequently evaluated as grade I or II. Occurrence of sternal and rib fractures was significantly higher in persons with PFE than between persons without PFE (p = 0.033 and p = <0.001). Number of rib fractures was also significantly higher in persons with PFE. The occurrence of serious intra-thoracic injuries was comparable in both our study groups (p = 0.089).

CONCLUSIONS

PFE presents a common resuscitation injury which can be found in more than 30% of persons after CPR. Persons with resuscitation skeletal chest fractures have significantly higher risk of PFE development. During autopsy of persons after unsuccessful CPR, it is necessary to distinguish CPR-associated injuries including PFE from injuries that arise from other mechanisms.

摘要

背景

钝性创伤作用于人体是导致肺脂肪栓塞（PFE）和脂肪栓塞综合征的根本原因。本研究旨在探讨心肺复苏（CPR）后非幸存者的 PFE 情况。

方法

这是一项在捷克奥斯特拉瓦大学医院进行的前瞻性队列研究。在 4 年的研究期间，对所有因院外心脏骤停而进行 CPR 但未存活的非幸存者进行了研究资格评估。通过对肺组织冷冻切片进行显微镜检查（油红 O 染色）来确定 PFE 的存在/严重程度。

结果

共有 106 名 CPR 后未存活的患者纳入本研究。研究人群中最常见的死亡原因（63.2%的病例）是心脏病（缺血性心脏病）；在我们的研究病例中，没有将 PFE 确定为死因。胸骨骨折在 66.9%的病例中被发现，肋骨骨折（通常为多发性）在 80.2%的病例中被发现；中位数每人有 10.2 处肋骨骨折。34.9%的病例存在严重的胸腔内损伤。对肺冷冻切片进行显微镜检查显示，40 例（37.7%）研究病例存在 PFE；PFE 最常被评估为 I 级或 II 级。有 PFE 的患者比没有 PFE 的患者发生胸骨和肋骨骨折的几率显著更高（p = 0.033 和 p <0.001）。有 PFE 的患者肋骨骨折的数量也明显更高。两组患者严重胸腔内损伤的发生率相当（p = 0.089）。