亞急性脂肪栓塞症候群之自然復原時程－－病例報告

Time Course of Spontaneous Recovery of Subacute Fat Embolism Syndrome-- A Case Report

肺部栓塞發生在具有高危險因子的骨科病人並非不常見。這些危險因子包括：長期臥床、肥胖、有靜脈栓塞之過去史或家族史、骨盆腔及長骨骨折。本篇病例報告是描述一位有殘餘腦部動靜脈血管畸形的年輕男性病人，在單一股骨骨析後，發生急性嚴重動脈低血氧。就吾人所知，有關於手術週期亞急性脂肪栓塞症候群之自然復原時程，本文卻屬第一次報導。相關麻醉處置之原則亦在文中予以討論。

Pulmonary embolism is not uncommonly encountered in orthopedic patients with high risks, such as prolonged immobility, obesity, past or family history of thromboembolism, pelvic and long bone fractures. Here we report a young male patient with a residual cerebral arteriovenous malformation post-craniotomy suffered from acute severe hypoxemia after sustaining a simple fracture of the left femur shaft from a motorcycle accident. The emergent surgery was deferred in view of suspectable pulmonary embolism. Under supportive treatment, the condition spontaneously resolved, and the surgery was later performed uneventfully. To the best of our knowledge, this was the first instance that a pulmonary embolism (suspected subacute fat embolism syndrome) which ran in a natural course to spontaneous resolution was observed. We would like to report our clinical observation, and discuss the principle of anesthetic management in the text.