Management of Fat Embolism Syndrome Using Extra-Corporeal Membrane Oxygenation: Report of 2 Cases

脂肪栓塞症候群病患使用葉克膜之兩病例報告

劉祥雯(Hsiang-Wen Liu) ； 郭炳宏(Ping-Hung Kuo)

《胸腔醫學》 28卷6期 (2013/12) Pp. 360-369

摘要

脂肪栓塞症候群是長骨骨折的併發症，主要的症狀有呼吸及神經系統異常和淤斑。脂肪栓塞症候群的嚴重度從輕微到致命都有，快速及正確的支持性療法是減少死亡率重要的一環。最近在世界各地的加護中心，體外循環維生系統常被用來治療嚴重呼吸及循環衰竭的病患，但此裝置對於改善脂肪栓塞而引起之呼吸衰竭仍未有定論。我們報告二例因脂肪栓塞症候群而產生嚴重低血氧情形之病患，在接受靜脈－靜脈型體外循環維生系統後，病人血氧明顯改善並在良好的狀況下出院。根據此篇結論，我們建議當病人出現因脂肪栓塞症候群引起之致命呼吸衰竭，在支持性療法失敗後，便可使用靜脈－靜脈型體外循環維生系統作為治療。

關鍵字

脂肪栓塞症候群 ； 體外循環維生系統 ； 葉克膜

並列摘要

Fat embolism syndrome (FES) is a condition characterized by pulmonary dysfunction, changes in mental status and petechial rash. Trauma to the long bones and pelvis is the major cause of FES. The severity of FES can range from sub-clinical to life-threatening. Immediate and appropriate resuscitation is essential to reduce mortality. Although extracorporeal membrane oxygenation (ECMO) has been used for severe respiratory and circulatory failure, its full potential as a rescue therapy for FES has yet to be exploited. In this report, we present 2 trauma cases with fulminant FES that were successfully treated with veno-venous ECMO. On the basis of the results of our report, we suggest that ECMO may be an appropriate therapy for patients with severe pulmonary FES who do not respond to supportive management.

並列關鍵字

fat embolism syndrome ； FES ； extra-corporeal membrane oxygenation ； ECMO