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目的:分析脂肪栓塞综合征(FES)在严重创伤患者中诊断延迟的原因,总结其诊治经验。方法:收集2007-01-2012-06我科收治多发伤患者5074例,其中发生FES患者25例,其中10例出现早期漏诊导致诊断延迟,发生率为40%。总结了该组患者临床资料,分析其延迟诊治的可能原因、临床治疗和预防措施。结果:10例并发长骨骨折的多发伤患者均为严重创伤(ISS≥16),伤后来我院就诊得到4~13 d明确诊断。最常见致伤原因为道路交通事故,其次为高处坠落和重物砸伤。10例患者中,7例治愈出院。2例转当地医院治疗,1例死亡,病死率10%。结论:提高对多发伤患者FES的认识,动态监测病情变化、及时处理骨折有助于减少创伤后脂肪栓塞综合征的发生。根据患者病情,选择恰当的治疗方案和内固定手术方式有助于改善创伤后脂肪栓塞综合征患者的预后。
OBJECTIVE: To analyze the causes of delayed diagnosis of fat embolism syndrome (FES) in patients with severe trauma and to summarize its experience of diagnosis and treatment. Methods: From January 2007 to June 2012, 5074 patients with multiple traumatic injuries were enrolled in our department. Twenty-five patients with FES were diagnosed. Among them, 10 cases had early missed diagnosis, which led to a delayed diagnosis of 40%. The clinical data of this group of patients were summarized and the possible causes, clinical treatments and preventive measures for delayed diagnosis and treatment were analyzed. Results: All ten trauma patients with long bone fracture were severe trauma (ISS≥16), and the diagnosis was confirmed after 4 to 13 days in our hospital. The most common causes of injuries were road accidents, followed by crashes and heavy objects. Of the 10 patients, 7 were cured and discharged. 2 cases transferred to the local hospital for treatment, 1 case died, the case fatality rate was 10%. Conclusion: To improve the understanding of FES in patients with multiple traumatic injuries, to dynamically monitor the changes of the disease and timely treatment of fractures will help reduce the incidence of post-traumatic fat embolism syndrome. According to the patient’s condition, choosing the appropriate treatment and internal fixation can help to improve the prognosis of patients with PTSD.