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血小板在脂肪栓塞综合征发病及诊断中的作用

张群 张伯勋 刘郑生 梁雨田 肖嵩华

摘 要:目的 探讨凝血系统的变化在脂肪栓塞综合征发病及诊断中的作用。 方法 健康杂种犬7只,通过静脉注射骨髓脂肪建立脂肪栓塞综合征动物模型。于各时相点检测动脉血氧分压、凝血相指标和血小板聚集率,于栓塞后 48 h处死动物并取肺组织行病理学检查。 结果 脂肪栓塞后,血小板随动脉血氧分压下降而呈进行性降低,栓塞前血小板浓度为 278×109/L,栓塞后 48 h下降为 72×109/L;血小板聚集率早期升高,24 h以后显著降低,栓塞前血小板聚集率为 35.7%,栓塞后12 h上升至 48.3%,栓塞后 48 h则下降为 25.1%;病理检查肺组织损伤严重。 结论 血小板聚集在脂肪栓塞综合征的发病中具有重要作用,血小板进行性减少可作为脂肪栓塞综合征早期诊断的重要依据。
关键词:栓塞; 脂肪; 血小板凝集

Platelet in occurrence and diagnosis of fat embolism syndrome

ZHANG Qun ZHANG Baixun LIU Zhengsheng, et al.
(Dept. of Orthopedics, General Hospital, PLA, Bejing 100853, China)

Abstract:Objective To study the role of changes of blood coagulation system in occurrence and diagnosis of fat embolism syndrome.  Methods Seven healthy hybrid dogs were used to establish the animal model of fat embolism syndrome by means of intravenous injection of bone marrow fat. Partial pressure of oxygen in arterial blood, coagulation indexes and platelet aggregation test were observed at various time. After 48 hours of embolism, all dogs were sacrificed and the lung tissues were examined pathologically.  Results After fat embolism, the patelets were reduced progressively as partial pressure of oxygen in arterial blood decreased. Platelet aggregation test showed that platelet concentration was 278×109 /L before embolism, but it was decreased to 72×109/L from 48 hours embolism. The platelets were increased in the early phase of platelet aggregation, but decreased after 24 hours. Before embolism, the platelet concentration ratio was 35.7%, but it was increased to 48.3% from 12 hours embolism, and then decreased to 25.1% after 48 hours embolism. Pathologic examination revealed serious injury to the lung tissues.  Conclusions Platelet aggregation plays an important role in occurrence of fat embolism syndrome, and progressive reduction of platelet can be considered an important evidence in the early diagnosis of fat embolism s

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