El-Solh A, Sikka P, Bozkanat E, Jaafar W, Davies J
Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, James P. Nolan Clinical Research Center, University at Buffalo School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.
Chest. 2001 Dec;120(6):1989-97. doi: 10.1378/chest.120.6.1989.
To describe the clinical course, complications, and prognostic factors of morbidly obese patients admitted to the ICU compared to a control group of nonobese patients.
A retrospective study.
Two university-affiliated hospitals.
We reviewed the medical records of 117 morbidly obese patients (body mass index >/= 40 kg/m(2)) admitted to the medical ICU between January 1994 and June 2000. Data collected included demographic information, comorbid condition, APACHE (acute physiology and chronic health evaluation) II score, invasive procedures, organ failure, and in-hospital mortality.
Obstructive airway disease, pneumonia, and sepsis were the main reasons for admission to the ICU in the morbidly obese group. Sixty-one percent of the morbidly obese patients and 46% of the nonobese group required mechanical ventilation (p = 0.02). The mean lengths of mechanical ventilation and ICU stay were significantly longer for the morbidly obese group (7.7 +/- 9.6 days and 9.3 +/- 10.5 days vs 4.6 +/- 7.1 days and 5.8 +/- 8.2 days, respectively; p < 0.001). APACHE II scores were not significantly different in the two groups (19.1 +/- 7.6 and 20.6 +/- 12.2; p = 0.6). Overall mortality was 30% for the morbidly obese patients and 17% for the nonobese group (p = 0.019). By multivariate analysis, multiorgan failure (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.1 to 16.6), PaO(2)/fraction of inspired oxygen < 200 for > 48 h (OR, 2.3; 95% CI, 1.2 to 7.8), and depressed left ventricular ejection fraction < 40% (OR, 1.4; 95% CI, 1.03 to 13.8) were independently associated with ICU mortality in the morbidly obese group.
We conclude that critically ill morbidly obese patients are at increased risk of morbidity and mortality compared to the nonobese patients.
描述入住重症监护病房（ICU）的病态肥胖患者与非肥胖对照组患者的临床病程、并发症及预后因素。
一项回顾性研究。
两家大学附属医院。
我们回顾了1994年1月至2000年6月间入住内科ICU的117例病态肥胖患者（体重指数≥40kg/m²）的病历。收集的数据包括人口统计学信息、合并症、急性生理与慢性健康状况评估（APACHE）II评分、侵入性操作、器官功能衰竭及院内死亡率。
阻塞性气道疾病、肺炎和脓毒症是病态肥胖组入住ICU的主要原因。61%的病态肥胖患者和46%的非肥胖组患者需要机械通气（p = 0.02）。病态肥胖组的机械通气平均时长和ICU住院时间显著更长（分别为7.7±9.6天和9.3±10.5天，对比4.6±7.1天和5.8±8.2天；p < 0.001）。两组的APACHE II评分无显著差异（19.1±7.6和20.6±12.2；p = 0.6）。病态肥胖患者的总体死亡率为30%，非肥胖组为17%（p = 0.019）。多因素分析显示，多器官功能衰竭（比值比[OR]，4.6；95%置信区间[CI]，2.1至16.6）、动脉血氧分压/吸入氧分数<200且持续>48小时（OR，2.3；95% CI，1.2至7.8）以及左心室射血分数降低<40%（OR，1.4；95% CI，1.03至13.8）与病态肥胖组的ICU死亡率独立相关。
我们得出结论，与非肥胖患者相比，危重病态肥胖患者的发病和死亡风险增加。
