骨折併發脂肪栓塞症 引發肺水腫 險要命

[MK]

http://tw.news.yahoo.com/article/url/d/ ... 1mv8r.html
更新日期:2009/07/11 04:09
記者徐夏蓮／台中報導


大腿骨折竟然成為肺水腫！台中市一名大學生，騎機車大腿骨折，骨折開刀3天後，突然喘不過氣，原來是骨中釋放出的脂肪，造成他的血管栓塞引發肺水腫，差點就出現「小小脂肪球要了他的命」的憾事。


台中醫院骨科醫師李宗哲昨天指出，這名20歲的大學男生，騎機車出車禍，左大腿骨折，手術第三天突然呼吸困難，胸部X光顯示有肺水腫，實驗室檢查及肺部斷層攝影證實他是骨折後，併發脂肪栓塞症候群，才會讓他喘不過氣來。


這位大男生很幸運，住院9天後，平安出院，李宗哲醫師說，曾有病例報告，有患者骨折後，因骨中釋放出的脂肪，造成血管栓塞，搶救不及而喪命，所以即使是小小骨折，也千萬不可小覷。


李宗哲醫師表示，骨折後出現脂肪栓塞的原因，有研究認為，是因為骨折破壞骨髓中的脂肪細胞，及破壞附近的小血管，使脂肪小球進入靜脈循環，而到達肺微血管，造成栓塞。


也有研究認為是外傷後，體內「鄰苯二酚胺」分泌，使游離脂肪酸從附近的脂肪組織中釋出，使乳糜小滴與其他血清脂肪結合，形成脂肪小球，由靜脈循環達到肺部，再分解為有毒的游離脂肪酸，傷害肺泡細胞，使纖維蛋白堆積，形成微血栓，造成肺泡水腫、出血及膨脹不全，最後造成肺功能不全。


他表示，脂肪栓塞症候群發生在受傷後72小時以內，雖然機率僅佔骨折人口的3%至4%，但這名大學生就是碰到了這種情形。一般說來，年紀大及有慢性疾病的患者骨折時，較易發生，小心骨折是預防之道。

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