Reider E, Sherman Y, Weiss Y, Liebergall M, Pizov R
Department of Anesthesiology and Critical Care Medicine, Hadassah University Hospital, Jerusalem, Israel.
Isr J Med Sci. 1997 Oct;33(10):654-8.
The aim of this study was to assess the contribution of bronchoalveolar lavage (BAL) in the diagnosis of fat embolism syndrome (FES). The presence of fat droplets in alveolar macrophages was addressed in 13 trauma patients with bone fractures and 10 non-trauma patients with acute respiratory distress syndrome (ARDS). The control group was composed of 5 anesthesized patients with ischemic heart disease, immediately prior to cardiac surgery. Two patients with suggestive clinical and laboratory signs of FES had 40% and 24% fat-containing alveolar cells, respectively. The trauma patients without signs of FES displayed a wide variation in the percentage of fat-containing macrophages (from 3% to 95%). Most of the patients with ARDS who were receiving lipid emulsion as part of their parenteral nutrition, had a high percentage (> 85%) of fat-containing macrophages. Patients with normal lungs had no fat-containing macrophages. Our findings suggest that BAL Oil Red O-positive macrophages are frequently observed in trauma patients irrespective of the presence of FES. Therefore, estimation of the percentage of fat-containing macrophages from BAL is an unreliable marker of FES.
本研究的目的是评估支气管肺泡灌洗（BAL）在脂肪栓塞综合征（FES）诊断中的作用。在13例骨折创伤患者和10例急性呼吸窘迫综合征（ARDS）非创伤患者中研究肺泡巨噬细胞中脂肪滴的存在情况。对照组由5例心脏手术前即刻麻醉的缺血性心脏病患者组成。2例有FES提示性临床和实验室体征的患者，其含脂肪肺泡细胞分别占40%和24%。无FES体征的创伤患者含脂肪巨噬细胞百分比差异很大（从3%到95%）。大多数接受脂质乳剂作为肠外营养一部分的ARDS患者，其含脂肪巨噬细胞百分比很高（>85%）。肺部正常的患者没有含脂肪巨噬细胞。我们的研究结果表明，无论是否存在FES，创伤患者中经常观察到BAL油红O阳性巨噬细胞。因此，通过BAL评估含脂肪巨噬细胞的百分比是FES的不可靠指标。
