Neville Angela L, Brown Carlos V R, Weng Janie, Demetriades Demetrios, Velmahos George C
Department of Surgery, Division of Trauma and Critical Care, Los Angeles County, University of Southern California Medical Center, Los Angeles 90033, USA.
Arch Surg. 2004 Sep;139(9):983-7. doi: 10.1001/archsurg.139.9.983.
Obesity is associated with increased morbidity and mortality in critically injured blunt trauma patients.
Case-control study of all critically injured blunt trauma patients between January 2002 and December 2002.
Academic level I trauma center at a county referral hospital.
Two hundred forty-two consecutive patients admitted to the intensive care unit following blunt trauma. Patients were divided into 2 groups by body mass index. The obese group was defined as having a body mass index of 30 kg/m2 or higher, and the nonobese group was defined as having a body mass index lower than 30 kg/m2.
Univariate and multivariate analyses were performed to identify risk factors for mortality. Complications and length of stay were also evaluated.
Of the 242 patients, 63 (26%) were obese, and 179 (74%) were nonobese. The obese and nonobese groups were similar with regard to age (mean +/- SD, 49 +/- 18 years vs 45 +/- 22 years), male sex (63% vs 72%), Glasgow Coma Scale score (mean +/- SD, 11 +/- 5 vs 11 +/- 5), and injury severity score (mean +/- SD, 21 +/- 13 vs 20 +/- 14). The obese group had a higher body mass index (mean +/- SD, 35 +/- 7 vs 24 +/- 3; P<.001). Mechanisms of injury and injury patterns were similar between groups. The obese group had a higher incidence of multiple organ failure (13% vs 3%; P =.02) and mortality (32% vs 16%; P=.008). Obesity was an independent predictor of mortality with an adjusted odds ratio of 5.7 (95% confidence interval, 1.9-19.6; P=.003).
Critically injured obese trauma patients have similar demographics and injury patterns as nonobese patients. Obesity is an independent predictor of mortality following severe blunt trauma.
在严重钝性创伤患者中，肥胖与发病率和死亡率增加相关。
对2002年1月至2002年12月期间所有严重钝性创伤患者进行病例对照研究。
一家县转诊医院的一级学术创伤中心。
242例钝性创伤后入住重症监护病房的连续患者。根据体重指数将患者分为两组。肥胖组定义为体重指数为30kg/m²或更高，非肥胖组定义为体重指数低于30kg/m²。
进行单因素和多因素分析以确定死亡风险因素。还评估了并发症和住院时间。
242例患者中，63例（26%）为肥胖患者，179例（74%）为非肥胖患者。肥胖组和非肥胖组在年龄（平均±标准差，49±18岁对45±22岁）、男性比例（63%对72%）、格拉斯哥昏迷量表评分（平均±标准差，11±5对11±5）和损伤严重程度评分（平均±标准差，21±13对20±14）方面相似。肥胖组的体重指数更高（平均±标准差，35±7对24±3；P<0.001）。两组之间的损伤机制和损伤模式相似。肥胖组多器官功能衰竭的发生率更高（13%对3%；P = 0.02），死亡率更高（32%对16%；P = 0.008）。肥胖是死亡的独立预测因素，调整后的优势比为5.7（95%置信区间，1.9 - 19.6；P = 0.003）。
严重钝性创伤的肥胖患者与非肥胖患者在人口统计学和损伤模式方面相似。肥胖是严重钝性创伤后死亡的独立预测因素。
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