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.
作者
王建
崔永建
冉建
Wang Jian;Cui Yongjian;Ran Jian(Department of Trauma Orthopedics,Sixth Affiliated Hospital of Xinjiang Medical University,Xinjiang 830000,China)
出处
《医学研究杂志》
2018年第12期140-144,26,共6页
Journal of Medical Research
基金
新疆医科大学科研创新基金资助项目(XYDCX2016106)
关键词
肺脂肪栓塞
骨折
肺组织活检
死亡
影响因素
Pulmonary fat embolism
Fracture
Lung biopsy
Death
Influence factor
