Alho A
Acta Chir Scand Suppl. 1980;499:75-85.
A special type of respiratory distress syndrome has been described in connection with fractures of the long bones, called fat embolism syndrome. In addition to the respiratory signs - tachypnoea, hypoxaemia and snow storm infiltrations in the chest x-ray films- the syndrome consists of petechiae, thrombocytopenia, cerebral disturbances, pyrexia etc. The respiratory insufficiency in this syndrome may be explained by a coagulation disorder, in which the release of tissue thromboplastins from the traumatized tissues results in an interstitial pneumonitis and peripheral thrombocytopenia. Accumulation of fat in the lung microvasculature has been observed both clinically and post morten. The importance of fat for the pathogenesis of the syndrome is not clear, but fat globuli are present in quantities, which are not encountered in other types of post-traumatic pulmonary insufficiency. Careful observation of a patient with multiple fractures is the cornerstone of early diagnosis. Cautions handling and early stabilization of fractures reduce the tissue trauma and may thus reduce the manifestations of the fat embolism syndrome. Respiratory assistance is given when necessary, and most often the syndrome is self-resolving. Fulminant cases with increasing symptomatology are treated with methylprednisolone and respirator.
一种特殊类型的呼吸窘迫综合征与长骨骨折相关，称为脂肪栓塞综合征。除了呼吸体征——呼吸急促、低氧血症以及胸部X光片上的暴风雪样浸润外，该综合征还包括瘀点、血小板减少、脑部功能障碍、发热等。该综合征中的呼吸功能不全可能由凝血障碍解释，其中创伤组织释放的组织凝血活酶导致间质性肺炎和外周血小板减少。临床上和尸检时均观察到肺微血管中有脂肪堆积。脂肪在该综合征发病机制中的重要性尚不清楚，但脂肪球的数量在其他类型的创伤后肺功能不全中并未出现。对多发性骨折患者进行仔细观察是早期诊断的基石。谨慎处理并早期固定骨折可减少组织创伤，从而可能减轻脂肪栓塞综合征的表现。必要时给予呼吸支持，而且该综合征大多可自行缓解。症状不断加重的暴发性病例用甲泼尼龙和呼吸机治疗。
