Fiallos M, Kissoon N, Abdelmoneim T, Johnson L, Murphy S, Lu L, Masood S, Idris A
Department of Pediatrics, University of Florida, Jacksonville, USA.
Am J Med Sci. 1997 Aug;314(2):73-9. doi: 10.1097/00000441-199708000-00008.
The objective of this prospective study was to assess the incidence and magnitude of fat emboli after cardiopulmonary resuscitation and intraosseous infusions. An animal laboratory at a university center was used to study 33 mixed-breed piglets. The piglets underwent hypoxic cardiac arrest followed by chest compressions and mechanical ventilation for a minimum of 30 minutes. The animals were divided in groups: group 1 (n = 5), which had no intraosseous cannulas, group 2 (n = 6), which had intraosseous cannulas with infusion, groups 3 (n = 6), 4 (n = 6), and 5 (n = 8), which had intraosseous cannulas with infusion of epinephrine, normal saline, and sodium bicarbonate respectively, and group 6 (n = 2), which was a sham group with no intraosseous cannulas and no cardiopulmonary resuscitation. At cessation of cardiopulmonary resuscitation, representative lung samples were collected from upper and lower lobes of each lung and observed for fat globules and bone marrow elements. Fat globules were seen in the peribronchial blood vessels and intravascular areas throughout all lung fields of groups 1 through 5. There was no difference in appearance or distribution of fat globules among the 5 treatment groups. Analysis of variance showed no statistical significance (P < 0.05) within or among groups 1 through 5. The use of the intraosseous cannula for infusion of emergency drugs and fluids did not increase the magnitude of fat embolization over cardiopulmonary resuscitation alone in this animal model. The benefits of using this procedure in critically ill children as a means of rapid vascular access for resuscitation is well established. However, the risk of fat embolism in this population needs further study.
这项前瞻性研究的目的是评估心肺复苏和骨内输注后脂肪栓子的发生率和严重程度。在一所大学中心的动物实验室对33只杂种仔猪进行了研究。仔猪经历缺氧性心脏骤停，随后进行胸部按压和机械通气至少30分钟。将动物分为几组：第1组（n = 5），未置入骨内套管；第2组（n = 6），置入骨内套管并进行输注；第3组（n = 6）、第4组（n = 6）和第5组（n = 8），分别置入骨内套管并输注肾上腺素、生理盐水和碳酸氢钠；第6组（n = 2），为假手术组，未置入骨内套管且未进行心肺复苏。在心肺复苏结束时，从每只肺的上叶和下叶采集代表性肺组织样本，观察脂肪球和骨髓成分。在第1组至第5组所有肺野的支气管周围血管和血管内区域均可见脂肪球。5个治疗组之间脂肪球的外观或分布没有差异。方差分析显示第1组至第5组内或组间无统计学意义（P < 0.05）。在该动物模型中，使用骨内套管输注急救药物和液体并不会比单纯心肺复苏增加脂肪栓塞的严重程度。在危重症儿童中使用该方法作为快速建立血管通路进行复苏的手段，其益处已得到充分证实。然而，该人群中脂肪栓塞的风险需要进一步研究。
