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患者男,32岁.因车祸致左下肢撞伤流血3h急诊入院,伤后神志清醒,双侧瞳孔等大同圆,光反射灵敏,皮肤无出血点,左大腿肿胀畸形.X线示:左股骨干中上1/3段骨折、左胫腓骨下1/3段骨折,左股骨干开放性骨折行清创梅花针内固定术、左小腿胫骨钢板内固定术.伤后9h患者出现反应迟钝,运动性失语,呼吸困难,继之昏迷.X线胸片示:右肺有暴风雪状纹理.脑MRI、CT检查见双侧额、颞边缘叶有多个脂肪栓点状影,脑水肿明显,同时后脑室角受压模糊.临床诊断为脂肪栓塞综合征,立即气管切开、吸氧,大剂量应用激素、甘露醇、抑肽酶能量合剂及预防感染,应用冬眠合剂控制抽搐等治疗,昏迷2周后患者逐渐清醒,3周后完全清醒,出血点渐消退,各项化验指标转为正常,体会 根据Gurd氏诊断标准,主要标准有三项:1.皮肤或结膜出血点;2.非胸部创伤的呼吸系统症状;3.非颅脑外伤的神经系统症状.次要标准2项:1.动脉低氧血症<8.0kpa;2.血红蛋白下降<100g/e.参考标准7项:1.发烧38℃以上;2.心率>120次/分;3.血沉增快>70mm;4.血小板减少;5.尿中脂滴;6.血清酯酶增高;7.血中游离脂肪酸上升.其中主要标准有2项,或主要标准只有一项,次要标准及参考标准有4项以上诊断可确定.本例有主要标准3项次要标准2项符合.参考标准4项符合,因此诊断明确.本病早期可与颅内
Male patient, aged 32, left leg injured due to a car accident, bleeding 3h emergency admission, post-traumatic consciousness, bilateral pupil and other Datong circle, light reflection sensitivity, no bleeding skin, left thigh swelling and deformity .X line shows: the left stock 1/3 fracture in the backbone, 1/3 fracture in the left tibia and fibula, 3: Open plum blossom pin fixation in the left femoral shaft and internal fixation in the left leg and tibial plateau. Aphasia, dyspnea, followed by coma .X-ray showed: the right lung has a snow-like texture .Both MRI, CT examination of the bilateral forehead, temporomandibular lobes have multiple fat plug-like shadow, cerebral edema significantly, at the same time Posterior ventricular angle pressure fuzzy clinical diagnosis of fat embolism syndrome, immediate tracheotomy, oxygen, high-dose hormone, mannitol, aprotinin energy mixture and the prevention of infection, the application of hibernation mixture control of convulsions and other coma 2 Week after the patient gradually awake, completely awake after 3 weeks, bleeding gradually subsided, the various laboratory tests turned normal, according to Gurd’s diagnostic criteria, there are three main criteria: 1. Skin or conjunctival bleeding point; 2. Non-chest trauma Respiratory symptoms; 3 non-craniocerebral injury neurological disorders The secondary standard 2: 1. Artery hypoxemia <8.0kpa; 2. Hemoglobin decreased <100g / e. Reference standard 7: 1. fever 38 ℃ or more; 2. heart rate> 120 beats / min; 3 . ESR> 70mm; 4. Thrombocytopenia; 5. Urinary lipid droplets; 6. Serum esterase increased; 7. Blood free fatty acids increased. There are two major criteria, or the main criteria of only one, secondary The standard and reference standards have more than 4 diagnosis can be determined in this case there are three major criteria 3 secondary standard line 2. Reference standard 4 line, so the diagnosis is clear. The early disease with intracranial