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目的探讨脑脂肪栓塞的早期诊断及治疗。方法回顾性分析颅脑外伤并发脑脂肪栓塞2例的临床资料。结果患者凝血机制在发病早期即发生改变,从最初的受伤时间计算活化部分凝血酶时间(APTT)与凝血酶原时间(PT)都是随着受伤天数先下降,后趋于稳定,D-二聚体(DD)从出现高值到后来的消失趋势;抗凝血酶Ⅲ被激活,抗凝活性增强,随着受伤时间下降,抗凝活性趋于正常。患者的影像学资料MRI提示两侧大脑半球、卵圆中心、基底节区及脑干可见多发斑点斑块状等T1、长T2异常信号影,液体衰减反转成像(FLAIR)呈高信号,DWI(弥散加权成像)呈高信号。结论通过早期的凝血机制改变结合影像学资料可以尽早诊断脑脂肪栓塞,使患者得到有效救治。
Objective To investigate the early diagnosis and treatment of cerebral fat embolism. Methods The clinical data of 2 cases with craniocerebral injury complicated with cerebral fat embolism were retrospectively analyzed. Results The coagulation mechanism changed at the early stage of the disease. The calculated APTT and PT from the initial injury time decreased first and then stabilized after D-di The polymer (DD) tended to disappear from the high value to the later. Antithrombin Ⅲ was activated and anticoagulant activity was enhanced. As the injury time decreased, anticoagulant activity tended to be normal. Imaging information of patients with MRI showed that T1, T2 abnormal signal, FLAIR showed high signal on both sides of the hemisphere, the center of the oval, the basal ganglia and the brainstem, multiple plaque spots, DWI (Diffuse weighted imaging) showed high signal. Conclusion Through the early coagulation mechanism changes combined with imaging data can be as early as possible diagnosis of cerebral fat embolism, so that patients receive effective treatment.