Brown Carlos V R, Neville Angela L, Rhee Peter, Salim Ali, Velmahos George C, Demetriades Demetrios
Department of Surgery, Division of Trauma and Critical Care, University of Southern California and the Los Angeles County Medical Center, Los Angeles, California 90033, USA.
J Trauma. 2005 Nov;59(5):1048-51; discussion 1051. doi: 10.1097/01.ta.0000189047.65630.c5.
Several small series have had mixed conclusions regarding the impact of obesity on outcomes of trauma patients. The purpose of the present study was to evaluate a large cohort of critically injured patients to better understand the influence of obesity on the outcomes of patients after severe blunt trauma.
Retrospective review using the trauma registry and intensive care unit (ICU) database of all blunt trauma patients admitted to the ICU at our urban, Level I trauma center over a 5-year period (1998-2003). Obese patients (body mass index [BMI] > or = 30 kg/m) were compared with non-obese patients (BMI < 30 kg/m).
There were 1,153 blunt trauma patients admitted to the ICU during the study period, including 283 (25%) obese (mean BMI = 35 +/- 6 kg/m) and 870 (75%) non-obese (mean BMI = 25 +/- 3 kg/m) patients. There was no difference between groups regarding age, sex, Injury Severity Score, or admission vitals. Obese patients had fewer head injuries (42 versus 55%; p = 0.0001) but more chest (45 versus 38%; p = 0.05) and lower extremity (53 versus 38%; p < 0.0001) injuries. There was no difference in the need for laparotomy, thoracotomy, or craniotomy. Obese patients suffered more complications (42 versus 32%; p = 0.002). Although there was only a trend toward higher mortality in obese patients (22 versus 17%; p = 0.10), stepwise logistic regression revealed obesity as an independent risk factor for mortality (odds ratio, 1.6; 95% confidence interval, 1.0-2.3; p = 0.03). Among survivors, obese patients required longer stays in the hospital (24 +/- 21 versus 19 +/- 17 days; p = 0.01), the ICU (13 +/- 14 versus 10 +/- 10 days; p = 0.005), and 2 more days of mechanical ventilation (8 +/- 13 versus 6 +/- 9 days; p = 0.07).
Obese patients incur different injuries after severe blunt trauma than their non-obese counterparts. Despite sustaining fewer head injuries, obese patients suffer more complications, require longer stays in the hospital, more days of mechanical ventilation, and obesity is independently associated with mortality.
关于肥胖对创伤患者预后的影响，几个小规模系列研究得出了不同结论。本研究的目的是评估一大群重伤患者，以更好地了解肥胖对严重钝性创伤患者预后的影响。
使用创伤登记册和重症监护病房（ICU）数据库，对我们城市一级创伤中心在5年期间（1998 - 2003年）收治入ICU的所有钝性创伤患者进行回顾性研究。将肥胖患者（体重指数[BMI]≥30 kg/m²）与非肥胖患者（BMI＜30 kg/m²）进行比较。
研究期间有1153例钝性创伤患者收治入ICU，其中包括283例（25%）肥胖患者（平均BMI = 35±6 kg/m²）和870例（75%）非肥胖患者（平均BMI = 25±3 kg/m²）。两组在年龄、性别、损伤严重程度评分或入院生命体征方面无差异。肥胖患者头部损伤较少（42%对55%；p = 0.0001），但胸部损伤较多（45%对38%；p = 0.05），下肢损伤也较多（53%对38%；p＜0.0001）。剖腹手术、开胸手术或开颅手术的需求无差异。肥胖患者并发症更多（42%对32%；p = 0.002）。虽然肥胖患者的死亡率仅呈上升趋势（22%对17%；p = 0.10），但逐步逻辑回归显示肥胖是死亡的独立危险因素（比值比，1.6；95%置信区间，1.0 - 2.3；p = 0.03）。在幸存者中，肥胖患者住院时间更长（24±21天对19±17天；p = 0.01），在ICU的时间更长（13±14天对10±10天；p = 0.005），机械通气时间多2天（8±13天对6±9天；p = 0.07）。
肥胖患者在严重钝性创伤后遭受的损伤与非肥胖患者不同。尽管头部损伤较少，但肥胖患者并发症更多，住院时间更长，机械通气天数更多，且肥胖与死亡率独立相关。
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