Schonfeld S A, Ploysongsang Y, DiLisio R, Crissman J D, Miller E, Hammerschmidt D E, Jacob H S
Ann Intern Med. 1983 Oct;99(4):438-43. doi: 10.7326/0003-4819-99-4-438.
The efficacy of corticosteroid treatment in the prophylaxis of the fat embolism syndrome was evaluated in a prospective, randomized, double-blind study of high-risk patients with long-bone fractures. Using a set of objective diagnostic criteria, we saw a significant difference in the incidence of the syndrome between corticosteroid- (0 of 21) and placebo-treated patients (9 of 41) (p less than 0.05). There were no complications related to corticosteroid treatment. No routine laboratory or physical findings reliably predicted the development of the fat embolism syndrome except petechial rash, which occurred only in 5 placebo-treated patients who developed the syndrome. Complement activation was present in all patients studied who had the syndrome (5 of 27) but also in many patients who did not meet our diagnostic criteria, suggesting a multifactorial cause. These data support the prophylactic value of corticosteroid treatment in patients at high risk for the fat embolism syndrome, particularly if several unfavorable predictors are present.
在一项针对长骨骨折高危患者的前瞻性、随机、双盲研究中，评估了皮质类固醇治疗预防脂肪栓塞综合征的疗效。根据一套客观诊断标准，我们发现皮质类固醇治疗组（21例中的0例）和安慰剂治疗组（41例中的9例）之间该综合征的发生率存在显著差异（p<0.05）。未出现与皮质类固醇治疗相关的并发症。除了瘀点皮疹外，没有常规实验室检查或体格检查结果能够可靠地预测脂肪栓塞综合征的发生，瘀点皮疹仅出现在5例发生该综合征的安慰剂治疗患者中。所有研究的患有该综合征的患者（27例中的5例）均存在补体激活，但许多不符合我们诊断标准的患者也存在补体激活，提示其病因是多因素的。这些数据支持皮质类固醇治疗对脂肪栓塞综合征高危患者的预防价值，特别是在存在多个不利预测因素的情况下。
