Richards R R
Department of Surgery, St. Michael's Hospital, Toronto, Ont.
Can J Surg. 1997 Oct;40(5):334-9.
Fat embolism syndrome, an important contributor to the development of acute respiratory distress syndrome, has been associated with both traumatic and nontraumatic disorders. Fat embolization after long bone trauma is probably common as a subclinical event. Fat emboli can deform and pass through the lungs, resulting in systemic embolization, most commonly to the brain and kidneys. The diagnosis of fat embolism syndrome is based on the patient's history, supported by clinical-signs of pulmonary, cerebral and cutaneous dysfunction and confirmed by the demonstration of arterial hypoxemia in the absence of other disorders. Treatment of fat embolism syndrome consists of general supportive measures, including splinting, maintenance of fluid and electrolyte balance and the administration of oxygen. Endotracheal intubation and mechanical ventilatory assistance can be indicated. The role of corticosteroids remains controversial. Early stabilization of long bone fractures has been shown to decrease the incidence of pulmonary complications. Clinical and experimental studies suggest that the exact method of fracture fixation plays a minor role in the development of pulmonary dysfunction. As more is learned about the specifics of the various triggers for the development of fat embolism syndrome, it is hoped that the prospect of more specific therapy for the prevention and treatment of this disorder will become a reality.
脂肪栓塞综合征是急性呼吸窘迫综合征发生发展的一个重要因素，与创伤性和非创伤性疾病均有关联。长骨创伤后的脂肪栓塞作为一种亚临床事件可能很常见。脂肪栓子可变形并通过肺部，导致全身栓塞，最常见于脑和肾。脂肪栓塞综合征的诊断基于患者病史，有肺、脑和皮肤功能障碍的临床体征支持，且在无其他疾病的情况下经动脉血氧不足证实。脂肪栓塞综合征的治疗包括一般支持措施，如夹板固定、维持液体和电解质平衡以及吸氧。可考虑气管插管和机械通气辅助。皮质类固醇的作用仍存在争议。已表明早期稳定长骨骨折可降低肺部并发症的发生率。临床和实验研究表明，骨折固定的确切方法在肺功能障碍的发生中起次要作用。随着对脂肪栓塞综合征发生发展的各种触发因素的具体情况了解得更多，希望针对这种疾病的预防和治疗采取更具体治疗方法的前景将成为现实。
