骨折并发肺脂肪栓塞患者骨折等级、栓塞程度与预后的关系
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摘要
目的探究肺脂肪栓塞患者骨折等级、栓塞程度与预后的关系,为临床治疗肺脂肪栓塞提供一定的参考。方法选取笔者医院收治的67例肺脂肪栓塞患者作为研究对象,患者均发生骨折,活检穿刺法检测肺组织脂肪栓塞程度,统计患者预后情况,采用Logistic多因素回归性分析影响患者预后的因素,Spearman分析临床参数间的相关性。结果患者经手术治疗后,36例患者出现死亡,病死率为53.73%。病理组织染色显示肺脂肪栓塞病理1级2例,2级31例,3级19例,4级15例。单因素分析显示性别、骨折部位、脂肪栓Sevitt分型、肺脂肪栓塞潜伏期、合并高血压、糖尿病患者生存率差异无统计学意义(P> 0.05)。年龄、BMI、骨折Gustilo-Anderson分级、肺脂肪栓塞程度、Gurd、Wilson评分、是否合并心肺疾病与患者生存率相关(P<0.05)。Logistic多因素回归性分析,结果显示骨折Gustilo-Anderson分级>Ⅲ级、肺脂肪栓塞病理分级>3级、Gurd、Wilson评分>7分是影响肺脂肪栓塞患者死亡的危险因素。Spearman相关性分析显示,骨折Gustilo-Anderson分级、肺脂肪栓塞病理分级、Gurd、Wilson评分三者间均呈显著正相关(P <0.05)。结论对于骨折严重者出现肺脂肪栓塞,应尽早进行肺组织活检以判定脂肪栓塞程度,进而对患者预后进行评定。
Objective To explore the relationship between the grade of fracture, relationship between the degree of embolism and the prognosis, so as to provide some reference for the clinical treatment of pulmonary fat embolism. Methods Totally 67 cases of pulmonary fat embolism in our hospital were selected as the research objects, and all the patients were fractured. Biopsies were used to detect the degree of fat embolism in the lung tissue, and the prognosis of the patients was statistically analyzed. Multivariate Logistic regression analysis was used to analyze factors that affected the prognostic, and Spearman was used to analyze the correlation between clinical parameters. Results After surgical treatment, 36 patients died, and the death rate was 53.73%. Pathological tissue staining showed that 2 cases were pathological grade 1 of pulmonary fat embolism, 31 cases were grade 2,19 cases were grade 3, and 15 cases were grade 4 Single factor analysis showed that there was no significant difference in survival rate between sex, fracture location, fat embolism Sevitt typing, pulmonary fat embolism latency, complicated hypertension and diabetes( P > 0.05). The survival rate was correlated to age, BMI, Gustilo-Anderson classification of fracture, degree of pulmonary fat embolism, Gurd Wilson score, and whether the combination of cardiopulmonary disease( P < 0. 05). Logistic multivariate regression analysis showed that fracture Gustilo-Anderson classification > Ⅲ, pulmonary fat embolism grade > 3 and Gurd Wilson score >7 were risk factors for mortality of patients with pulmonary fat embolism. Spearman correlation analysis showed that there was a significant positive correlation between fracture Gustilo-Anderson grading, pulmonary fat embolism pathological grading, Gurd and Wilson score(P <0.05). Conclusion Lung tissue biopsy should be carried out as early as possible to determine the degree of fat embolism and evaluate the prognosis of severe fracture patients with pulmonary fat embolism.
Objective To explore the relationship between the grade of fracture, relationship between the degree of embolism and the prognosis, so as to provide some reference for the clinical treatment of pulmonary fat embolism. Methods Totally 67 cases of pulmonary fat embolism in our hospital were selected as the research objects, and all the patients were fractured. Biopsies were used to detect the degree of fat embolism in the lung tissue, and the prognosis of the patients was statistically analyzed. Multivariate Logistic regression analysis was used to analyze factors that affected the prognostic, and Spearman was used to analyze the correlation between clinical parameters. Results After surgical treatment, 36 patients died, and the death rate was 53.73%. Pathological tissue staining showed that 2 cases were pathological grade 1 of pulmonary fat embolism, 31 cases were grade 2,19 cases were grade 3, and 15 cases were grade 4 Single factor analysis showed that there was no significant difference in survival rate between sex, fracture location, fat embolism Sevitt typing, pulmonary fat embolism latency, complicated hypertension and diabetes( P > 0.05). The survival rate was correlated to age, BMI, Gustilo-Anderson classification of fracture, degree of pulmonary fat embolism, Gurd Wilson score, and whether the combination of cardiopulmonary disease( P < 0. 05). Logistic multivariate regression analysis showed that fracture Gustilo-Anderson classification > Ⅲ, pulmonary fat embolism grade > 3 and Gurd Wilson score >7 were risk factors for mortality of patients with pulmonary fat embolism. Spearman correlation analysis showed that there was a significant positive correlation between fracture Gustilo-Anderson grading, pulmonary fat embolism pathological grading, Gurd and Wilson score(P <0.05). Conclusion Lung tissue biopsy should be carried out as early as possible to determine the degree of fat embolism and evaluate the prognosis of severe fracture patients with pulmonary fat embolism.
引文
1金涌,彭秋菊,高想杰,等.脂肪栓塞综合征的诊治体会(附11例报道)[J].中华神经医学杂志,2015, 14(8):843-845
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3尹国强,胡坤,马汉宁,等.早期评判脂肪栓塞综合征的诊断性试验研究[J].中华急诊医学杂志,2013, 22(9):1011-1015
4 Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta[J].Br J Surg, 1977, 64(3):166-173
5 Gurd AR, Wilson RI. The fat embolism syndrome[J]. J Bone Joint Surg Br,1974,56(3):408-416
6 Papakostidis C, Kanakaris N K, Pretel J, et al. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification[J]. Injury, 2011,42(12):1408-1413
7尹国强,胡坤,马汉宁,等.早期评判脂肪栓塞综合征的诊断性试验研究[J].中华急诊医学杂志,2013,22(9):1011-1015
8 Ahmadzai H, Campbell S, Archis C, et al. Fat embolism syndrome following percutaneous vertebroplasty:a case report[J]. Spine J,2014, 14(4):1-5
9 Kellogg RG, Fontes RB, Lopes DK. Massive cerebral involvement in fat embolism syndrome and intracranial pressure management[J]. J Neurosurg, 2013, 119(5):1263-1270
10朱星昀,刘杉杉,闫军浩.脂肪栓塞综合征肺损伤病生理机制浅析[J].生理科学进展,2017,48(5):243-247
11陈娇.急性肺损伤动物模型的研究现状[J].医学研究生学报,2013, 26(8):851-854
12 Takada M, Chiba S, Nagai T, et al. Inflammatory responses to neutral fat and fatty acids in multiple organs in a rat model of fat embolism syndrome[J]. Forensic Sci Int, 2015, 254:126-132
13 Lin CC, Liu PH, Kao SJ, et al. Effects of phorbol myristate acetate and sivelestat on the lung injury caused by fat embolism in isolated lungs.[J]. J Biomed Sci, 2012, 19(1):1-11
14王华松,蔡贤华,刘曦明,等.骨折并脂肪栓塞综合征内固定术后复发的临床分析[J].中华创伤骨科杂志,2013, 15(6):505-508
15 Li S, Zou D, Qin Z, et al. Nonfracture-associated pulmonary fat embolism after blunt force fatality:case report and review of the literature[J]. Am J Forensic Med Pathol, 2015, 36(2):61-66
16张瑾怀,李永宏.胫腓骨骨折内固定术后并发肺脂肪栓塞死亡1例[J].法医学杂志,2013,29(6):482
17 Law HL, Wong SL, Tan S. Computed tomographic findings of cerebral fat embolism following multiple bone fractures[J]. Singapore Med J, 2013, 54(2):28-33
18 Jarmer J, Ampanozi G, Thali MJ, et al. Role of survival time and injury severity in fatal pulmonary fat embolism[J]. Am J Forensic Med Pathol, 2017, 38(1):74-77
19 Stein L, Herold R, Austin A, et al. Fat emboli syndrome in a child with duchenne muscular dystrophy after minor trauma[J]. J Emerg Med, 2016, 50(5):223-226
20 Ebina M, Inoue A, Atsumi T, et al. Concomitant fat embolism syndrome and pulmonary embolism in a patient with a femoral shaft fracture[J]. Acute Med Surg, 2015, 3(2):135-138
21 Tsitsikas DA, Gallinella G, Patel S, et al. Bone marrow necrosis and fat embolism syndrome in sickle cell disease:increased susceptibility of patients with non-SS genotypes and a possible association with human parvovirus B19 infection[J]. Blood Rev, 2014, 28(1):23-30
22 Nandi R, Venkategowda PM, Mutkule D, et al. Fat embolism syndrome:Case report of a clinical conundrum[J]. J Anaesthesiol Clin Pharmacol., 2014, 30(3):412-414
23 Piolanti M, Dalpiaz G, Scaglione M, et al. Fat embolism syndrome:lung computed tomography findings in 18 patients[J]. J Comput Assist Tomogr, 2016, 40(3):335-339
24窦国宴,范钦和.老年人外伤死亡与肺脂肪栓塞病理学分级的关系[J].实用老年医学,2017,31(7):643-645
2唐春香,张龙江,卢光明.脂肪栓塞综合征及其影像学表现[J].临床放射学杂志,2013, 32(8):1206-1208
3尹国强,胡坤,马汉宁,等.早期评判脂肪栓塞综合征的诊断性试验研究[J].中华急诊医学杂志,2013, 22(9):1011-1015
4 Sevitt S. The mechanisms of traumatic rupture of the thoracic aorta[J].Br J Surg, 1977, 64(3):166-173
5 Gurd AR, Wilson RI. The fat embolism syndrome[J]. J Bone Joint Surg Br,1974,56(3):408-416
6 Papakostidis C, Kanakaris N K, Pretel J, et al. Prevalence of complications of open tibial shaft fractures stratified as per the Gustilo-Anderson classification[J]. Injury, 2011,42(12):1408-1413
7尹国强,胡坤,马汉宁,等.早期评判脂肪栓塞综合征的诊断性试验研究[J].中华急诊医学杂志,2013,22(9):1011-1015
8 Ahmadzai H, Campbell S, Archis C, et al. Fat embolism syndrome following percutaneous vertebroplasty:a case report[J]. Spine J,2014, 14(4):1-5
9 Kellogg RG, Fontes RB, Lopes DK. Massive cerebral involvement in fat embolism syndrome and intracranial pressure management[J]. J Neurosurg, 2013, 119(5):1263-1270
10朱星昀,刘杉杉,闫军浩.脂肪栓塞综合征肺损伤病生理机制浅析[J].生理科学进展,2017,48(5):243-247
11陈娇.急性肺损伤动物模型的研究现状[J].医学研究生学报,2013, 26(8):851-854
12 Takada M, Chiba S, Nagai T, et al. Inflammatory responses to neutral fat and fatty acids in multiple organs in a rat model of fat embolism syndrome[J]. Forensic Sci Int, 2015, 254:126-132
13 Lin CC, Liu PH, Kao SJ, et al. Effects of phorbol myristate acetate and sivelestat on the lung injury caused by fat embolism in isolated lungs.[J]. J Biomed Sci, 2012, 19(1):1-11
14王华松,蔡贤华,刘曦明,等.骨折并脂肪栓塞综合征内固定术后复发的临床分析[J].中华创伤骨科杂志,2013, 15(6):505-508
15 Li S, Zou D, Qin Z, et al. Nonfracture-associated pulmonary fat embolism after blunt force fatality:case report and review of the literature[J]. Am J Forensic Med Pathol, 2015, 36(2):61-66
16张瑾怀,李永宏.胫腓骨骨折内固定术后并发肺脂肪栓塞死亡1例[J].法医学杂志,2013,29(6):482
17 Law HL, Wong SL, Tan S. Computed tomographic findings of cerebral fat embolism following multiple bone fractures[J]. Singapore Med J, 2013, 54(2):28-33
18 Jarmer J, Ampanozi G, Thali MJ, et al. Role of survival time and injury severity in fatal pulmonary fat embolism[J]. Am J Forensic Med Pathol, 2017, 38(1):74-77
19 Stein L, Herold R, Austin A, et al. Fat emboli syndrome in a child with duchenne muscular dystrophy after minor trauma[J]. J Emerg Med, 2016, 50(5):223-226
20 Ebina M, Inoue A, Atsumi T, et al. Concomitant fat embolism syndrome and pulmonary embolism in a patient with a femoral shaft fracture[J]. Acute Med Surg, 2015, 3(2):135-138
21 Tsitsikas DA, Gallinella G, Patel S, et al. Bone marrow necrosis and fat embolism syndrome in sickle cell disease:increased susceptibility of patients with non-SS genotypes and a possible association with human parvovirus B19 infection[J]. Blood Rev, 2014, 28(1):23-30
22 Nandi R, Venkategowda PM, Mutkule D, et al. Fat embolism syndrome:Case report of a clinical conundrum[J]. J Anaesthesiol Clin Pharmacol., 2014, 30(3):412-414
23 Piolanti M, Dalpiaz G, Scaglione M, et al. Fat embolism syndrome:lung computed tomography findings in 18 patients[J]. J Comput Assist Tomogr, 2016, 40(3):335-339
24窦国宴,范钦和.老年人外伤死亡与肺脂肪栓塞病理学分级的关系[J].实用老年医学,2017,31(7):643-645