Stehman Christine R, Buckley Robert G, Dos Santos Frank L, Riffenburgh Robert H, Swenson Aaron, Mulligan Sheila, Mjos Nathan, Brewer Matt
Naval Medical Center, San Diego, California 92134, USA.
J Emerg Med. 2011 Jul;41(1):97-101. doi: 10.1016/j.jemermed.2009.12.016. Epub 2010 Mar 2.
Ideal body weight (IBW), which can be calculated using the variables of true height and sex, is important for drug dosing and ventilator settings. True height often cannot be measured in the emergency department (ED).
Determine the most accurate method to estimate IBW using true height-based IBW that uses true height estimated by providers or patients compared to true height estimated by a regression formula using measured tibial length, and compare all to the conventional 70 kg male/60 kg female standard IBW.
Prospective, observational, double-blind, convenience sampling of stable adult patients in a tertiary care ED from September 2004 to April 2006. Derivation set (215 patients) had blinded provider and patient true height estimates and tibial length measurements compared to gold-standard standing true height. A validation set (102 patients) then compared the accuracy of IBW using true height calculated from the regression formula vs. IBW using gold-standard true height. Regression formula for men tibial length-IBW (kg) = 25.83 + 1.11 × tibial length; for women tibial length-IBW = 7.90 + 1.20 × tibial length; R(2) = 0.89, p < 0.001. Inter-rater correlation of tibial length was 0.94.
Derivation set: percent within 5 kg of true height-based IBW for men/women =
91.1%:/85.7%; Physician: 66.1%/45.1%; Nurse: 65.7%/ 47.3%; tibial length: 66.1%/63.7%; and 70 kg male/60 kg female standard 46%/75%. Validation set: tibial length-IBW estimates were within 5 kg of true height-ideal body weight in only 56.2% of men and 42.2% of women.
PATIENT-reported height is the best bedside method to estimate true height to calculate ideal body weight. Physician and nurse estimates of true height are substantially less accurate, as is true height obtained from a regression formula that uses measured tibial length. All methods were more accurate than using the conventional 70 kg male/60 kg female IBW standard.
理想体重（IBW）可根据实际身高和性别的变量计算得出，对于药物剂量计算和呼吸机设置很重要。在急诊科（ED）通常无法测量实际身高。
确定使用基于实际身高的理想体重来估算理想体重的最准确方法，该方法使用由医护人员或患者估算的实际身高，并与使用测量的胫骨长度通过回归公式估算的实际身高进行比较，并将所有方法与传统的70kg男性/60kg女性标准理想体重进行比较。
2004年9月至2006年4月在一家三级护理急诊科对稳定的成年患者进行前瞻性、观察性、双盲、便利抽样。推导集（215例患者）对医护人员和患者的实际身高估算值以及胫骨长度测量值进行了盲法处理，并与金标准站立实际身高进行比较。然后，验证集（102例患者）比较了使用回归公式计算的实际身高得出的理想体重与使用金标准实际身高得出的理想体重的准确性。男性胫骨长度-理想体重的回归公式（kg）=25.83+1.11×胫骨长度；女性胫骨长度-理想体重=7.90+1.20×胫骨长度；R²=0.89，p<0.001。胫骨长度的评分者间相关性为0.94。
推导集：男性/女性基于实际身高的理想体重在实际体重±5kg范围内的百分比=
91.1%:/85.7%；医生：66.1%/45.1%；护士：65.7%/47.3%；胫骨长度：66.1%/63.7%；以及70kg男性/60kg女性标准为46%/75%。验证集：仅56.2%的男性和42.2%的女性中，胫骨长度-理想体重估算值在实际身高-理想体重±5kg范围内。
患者报告的身高是估算实际身高以计算理想体重的最佳床旁方法。医生和护士对实际身高的估算准确性明显较低，使用测量的胫骨长度通过回归公式得出的实际身高也是如此。所有方法都比使用传统的70kg男性/60kg女性理想体重标准更准确。
