Winfield Robert D, Delano Matthew J, Lottenberg Lawrence, Cendan Juan C, Moldawer Lyle L, Maier Ronald V, Cuschieri Joseph
Laboratory of Inflammation Biology and Surgical Science, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA.
J Trauma. 2010 Feb;68(2):317-30. doi: 10.1097/TA.0b013e3181caab6c.
Obesity is a risk factor for postinjury complications; in particular, obese patients develop multiple organ failure (MOF) at a greater rate than do normal weight counterparts. Evaluation of differences in resuscitative practices altered by body mass index (BMI) might provide an explanation for the increased risk of MOF seen in these high-risk patients.
We used prospectively collected multicenter data to retrospectively compare patients grouped by BMI with regard to resuscitation volumes and traditional end points during the first 48 hours after injury. Marshall MOF score was used as the primary outcome measure.
One thousand sixty-six patients were analyzed, with 877 meeting inclusion and exclusion criteria. All patients received similar volumes of resuscitation per kilogram lean and ideal body weight. Morbidly obese patients attained greater central venous pressures but otherwise differed little in attainment of standard cardiovascular end points. Despite this, morbidly obese patients resolved base deficit more slowly and remained in metabolic acidosis for 48 hours postinjury. Morbidly obese patients with persistent metabolic acidosis developed MOF at a significantly greater rate than did normal weight patients with or without persistent metabolic acidosis.
Morbidly obese trauma patients show prolonged metabolic acidosis despite receiving similar volumes and attaining similar end points of resuscitation when compared with patients in other BMI groups. Inadequate resuscitation based on inaccurate end points and metabolic disturbances associated with increased BMI are likely responsible; identification of the etiology, sources, and consequences of this acidosis may provide further insight into the susceptibility of the morbidly obese patient to develop postinjury organ failure.
肥胖是损伤后并发症的一个危险因素；特别是，肥胖患者发生多器官功能衰竭（MOF）的几率高于正常体重者。评估因体重指数（BMI）改变的复苏措施差异，可能为这些高危患者中MOF风险增加提供解释。
我们使用前瞻性收集的多中心数据，回顾性比较按BMI分组的患者在损伤后最初48小时内的复苏量和传统终点指标。Marshall多器官功能衰竭评分用作主要结局指标。
对1066例患者进行了分析，其中877例符合纳入和排除标准。所有患者每千克去脂体重和理想体重接受的复苏量相似。病态肥胖患者的中心静脉压更高，但在达到标准心血管终点指标方面差异不大。尽管如此，病态肥胖患者碱缺失纠正更慢，损伤后48小时仍处于代谢性酸中毒状态。与有或没有持续性代谢性酸中毒的正常体重患者相比，有持续性代谢性酸中毒的病态肥胖患者发生MOF的几率显著更高。
与其他BMI组的患者相比，病态肥胖创伤患者尽管接受了相似的复苏量并达到了相似的复苏终点，但仍表现出代谢性酸中毒持续时间延长。基于不准确终点指标的复苏不足以及与BMI增加相关的代谢紊乱可能是原因所在；确定这种酸中毒的病因、来源和后果，可能会进一步深入了解病态肥胖患者发生损伤后器官衰竭的易感性。
