改良创伤严重度评分与药物在预防骨创伤脂肪栓塞的应用Revised injury severity score combined with the drug therapy for prevention of fat embolism syndrome secondary to musculoskeletal trauma
覃宇宙;蔡贤华;刘曦明;谭宗奎;钟炎军;
摘要(Abstract):
[目的]观察改良创伤严重度评分法(RISS)结合药物预防骨创伤并发脂肪栓塞(FES)的效果。[方法]采用前瞻性研究2016年3月~2017年10月收治的骨创伤患者1305例,根据是否合并胸、腹、颅脑等其他部位的多发损伤和RISS分值,将患者分为四组:A组104例为单纯四肢长管状骨骨折,RISS分值<11分;B组256例为单纯四肢长管状骨骨折,RISS分值≥11分;C组358例为四肢长管状骨骨折同时合并有多发损伤,RISS分值<18分;D组587例为四肢长管状骨骨折同时合并有多发损伤,且RISS分值≥18分。其中A、C两组不给予药物预防措施,B、D两组给予低分子右旋糖酐加地塞米松药物预防,观察FES的预防效果。[结果] 1 305例骨创伤患者中,发生临床FES 3例,男女比例为2:1,平均年龄为(38.32±13.22)岁。A组和C组均无FES发生;B组发生1例FES,RISS分值为13分;D组发生2例FES,其RISS分值分别为21分和25分。各组患者性别、年龄和入院时间差异无统计学意义(P>0.05),各组RISS值比较差异具有统计学意义(P<0.05)。[结论]应用RISS评分法对骨创伤易并发FES患者进行快速筛选并给予药物预防,有肋于降低FES的发病率。
关键词(KeyWords): 骨创伤;创伤严重度改良评分法;脂肪栓塞综合征;预防
基金项目(Foundation): 湖北省卫生计生科研基金(编号:WJ2015MA013)
作者(Author): 覃宇宙;蔡贤华;刘曦明;谭宗奎;钟炎军;
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参考文献(References):
- [1] Akoh CC, Schick C, Otero J. Fat embolism syndrome after femur fracture fixation:a case report[J]. Iowa Orthop J, 2014, 34(1):55-62.
- [2] Tsai IT, Hsu CJ, Chen YH, et al. Fat embolism syndrome in long bone fracture--clinical experience in a tertiary referral center in Taiwan[J]. J Chin Med Assoc, 2010, 73(8):407-410.
- [3] Sharma RM, Setlur R, Upadhyay KK, et al. Fat embolism syndrome:a diagnostic dilemma[J]. Med J Armed Forces India,2007, 63(4):394-396.
- [4] Shaikh N. Emergency management of fat embolism syndrome[J]. J Emerg Trauma Shock, 2009, 2(1):29-33.
- [5] Cavallazzi R. The effect of corticosteroids on the prevention of fat embolism syndrome after long bone fracture of the lower limbs:a systematic review and meta-analysis[J]. J Bras Pneumol, 2008,34(1):34-41.
- [6] Gebhard KL. Relationship between systemic corticosteroids and osteonecrosis[J]. Am J Clin Dermatol, 2001, 2(6):377-388.
- [7]谭宗奎,唐运章,郑玉明,等.创伤严重度改良评分法改进的研究[J].中华外科杂志, 1994, 32(4):201-203.
- [8]谭宗奎,陈庄洪,蔡贤华,等.创伤严重度改良评分法对2660例创伤患者的前瞻性研究[J].中华创伤骨折杂志, 2007, 9(3):236-238.
- [9]蔡贤华,刘曦明,谭宗奎,等.骨创伤并发脂肪栓塞综合征损伤严重度预警参数探讨[J].创伤外科杂志, 2014, 17(1):17-19.
- [10]蔡贤华,唐运章,陈庄洪,等.低分子右旋糖酐加地塞米松预防脂肪栓塞综合征的临床研究[J].华南国防医学杂志, 2004, 18(4):12-14.
- [11] Liu XM, Huang JC, Wang GD, et al. Clinical effectiveness analysis of dextran 40 plus dexamethasone on the prevention of fat embolism syndrome[J]. Int J Clin Exp Med, 2014, 7(8):2343-2346.
- [12] Parisi DM, Koval K. Fat embolism syndrome[J]. Am J Orthop(Belle Mead NJ), 2002, 31(9):507-512.
- [13]美国机动车医学促进会(AAAM).简明损伤定级标准2005第二版.重庆市急救医疗中心译[M].重庆:重庆出版社, 2005:1-35.
- [14] Kosova E, Bergmark B. Fat embolism syndrome[J]. Circulation,2015, 131(3):317-320.
- [15] White TO, Jenkins PJ, Smith RD, et al. The epidemiology of posttraumatic adult respiratory distress syndrome[J]. J Bone Joint Surg Am, 2004, 86(11):2366-2376.
- [16] Stein PD, Yaekoub AY, Matta F, et al. Fat embolism syndrome[J].Am J Med Sci, 2008, 3369(6):472-477.
- [17] Kleinert K, Marug D, Soklic P. Fat embolism syndrome following lower limb fracture despite rapid external fixation, two case reports and review of the literature[J]. Unfallchirurg, 2009, 112(9):796-798.
- [18] Power KA, Talbot LA. Fat embolism syndrome after femur fracture with intramedullary nailing:a case report[J]. Am J Crit Care,2011, 20(3):264-266.
- [19] Bolliger SA, Muehlematter K, Thali MJ, et al. Correlation of fat embolism severity and subcutaneous fatty tissue crushing and bone fractures[J]. Int J Legal, 2011, 125(3):453-458.
- [20] Hysa E. Fat embolism among patients with hip and long bone fractures in Albania[J]. Materia Socio-Medica, 2012, 24(4):248-250.
- [21] Kubota T, Ebina T, Tonosaki M, et al. Rapid improvement of respiratory symptoms associated with fat embolism by high-dose methylpredonisolone:a case report[J]. J Anesth, 2003, 17(3):186-189.
- [22] Han YY. An evidence-based review on the use of corticosteroids in peri-operative and critical care[J]. Acta Anaesthesiol Sin,2002, 40(2):71-79.
- [23] George J, George R, Dixit R, et al. Fat embolism syndrome[J].Lung India, 2013, 309(1):47-53.