Duane Therèse M, Dechert Tracey, Aboutanos Michel B, Malhotra Ajai K, Ivatury Rao R
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
J Trauma. 2006 Nov;61(5):1218-21. doi: 10.1097/01.ta.0000241022.43088.e1.
Obesity has proven to be an independent risk factor of mortality in the intensive care unit (ICU) in both nontrauma and trauma patients. The purpose of this study was to determine whether the detrimental effect of obesity extend to morbidity as well as mortality in the intensive and nonintensive care blunt trauma patients.
A retrospective comparison of obese (body mass index [BMI] > 30 kg/m2) to nonobese (BMI < 30 kg/m2) blunt trauma patients was performed between January 2004 and December 2005. Patient demographics, morbidity, mortality and ventilator, ICU, and hospital length of stays were analyzed. Continuous variables were evaluated using the Wilcoxon Rank test and the nominal variables were evaluated using the Fisher's exact test.
A cohort of 338 nonobese patients was compared with 115 obese patients during the study. These groups were similar in age (p = 0.19), gender (p = 0.37), and mechanism (p = 0.13). Their severity of injury were similar, demonstrated by nonsignificant differences in Injury Severity Score (p = 0.45), New Injury Severity Score (p = 0.51), Abdomen Abbreviated Injury Score (AIS; p = 0.49), and head AIS (p = 0.64). The subset of obese patients who never went to the ICU had a slightly longer hospital stay with a p value of 0.055. Overall the mortality rates were not different between the groups (3.5% obese versus 7.1% nonobese, p = 0.26).
This group of obese blunt trauma patients had similar mortality rates to their leaner counterparts possibly because their complications were minimized. Despite this finding, a subset of obese patients had longer hospital stays which increases the financial burden to the patient and hospital. Effort should be made to facilitate their discharge to avoid complications and minimize cost.
肥胖已被证明是重症监护病房（ICU）中非创伤和创伤患者死亡的独立危险因素。本研究的目的是确定肥胖的有害影响是否也延伸至重症和非重症监护钝性创伤患者的发病率和死亡率。
对2004年1月至2005年12月期间肥胖（体重指数[BMI]>30kg/m²）与非肥胖（BMI<30kg/m²）钝性创伤患者进行回顾性比较。分析患者的人口统计学、发病率、死亡率以及呼吸机使用情况、ICU住院时间和住院时间。连续变量采用Wilcoxon秩和检验进行评估，名义变量采用Fisher精确检验进行评估。
研究期间，将338例非肥胖患者与115例肥胖患者进行了比较。这些组在年龄（p = 0.19）、性别（p = 0.37）和受伤机制（p = 0.13）方面相似。他们的损伤严重程度相似，损伤严重程度评分（p = 0.45）、新损伤严重程度评分（p = 0.51）、腹部简明损伤评分（AIS；p = 0.49）和头部AIS（p = 0.64）差异均无统计学意义。从未入住ICU的肥胖患者亚组住院时间略长，p值为0.055。总体而言，两组的死亡率没有差异（肥胖组为3.5%，非肥胖组为7.1%，p = 0.26）。
这组肥胖钝性创伤患者的死亡率与较瘦的患者相似，可能是因为他们的并发症降至最低。尽管有这一发现，但一部分肥胖患者住院时间较长，这增加了患者和医院的经济负担。应努力促进他们出院，以避免并发症并降低成本。
