体重指数与院内心脏骤停后的生存率
Body mass index and survival after in-hospital cardiac arrest.
作者信息
Jain Renuka, Nallamothu Brahmajee K, Chan Paul S
机构信息
Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA.
出版信息
Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):490-7. doi: 10.1161/CIRCOUTCOMES.109.912501. Epub 2010 Aug 10.
BACKGROUND
The quality and effectiveness of resuscitation processes may be influenced by the patient's body mass index (BMI); however, the relationship between BMI and survival after in-hospital cardiac arrest has not been previously studied.
METHODS AND RESULTS
We evaluated 21 237 adult patients with an in-hospital cardiac arrest within the National Registry for Cardiopulmonary Resuscitation (NRCPR). We examined the association between BMI (classified as underweight [<18.5 kg/m(2)], normal [18.5 to 24.9 kg/m(2)], overweight [25.0 to 29.9 kg/m(2)], obese [30.0 to 34.9 kg/m(2)], and very obese [≥35.0 kg/m(2)]) and survival to hospital discharge using multivariable logistic regression, after stratifying arrests by rhythm type and adjusting for patient characteristics. Of 4499 patients with ventricular fibrillation or pulseless ventricular tachycardia as initial rhythm, 1825 (40.6%) survived to discharge. After multivariable adjustment, compared with overweight patients, underweight (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.41 to 0.84; P=0.003), normal weight (OR, 0.75; 95% CI, 0.63 to 0.89; P<0.001), and very obese (OR, 0.78; 95% CI, 0.63 to 0.96; P=0.02) had lower rates of survival, whereas obese patients had similar rates of survival (OR, 0.87; 95% CI, 0.72 to 1.06; P=0.17). In contrast, of 16 738 patients with arrests caused by asystole or pulseless electric activity, only 2501 (14.9%) survived. After multivariable adjustment, all BMI groups had similar rates of survival except underweight patients (OR, 0.67; 95% CI, 0.54 to 0.82; P<0.001).
CONCLUSIONS
For cardiac arrest caused by shockable rhythms, underweight, normal weight, and very obese patients had lower rates of survival to discharge. In contrast, for cardiac arrest caused by nonshockable rhythms, survival to discharge was similar across BMI groups except for underweight patients. Future studies are needed to clarify the extent to which BMI affects the quality and effectiveness of resuscitation measures.
背景
复苏过程的质量和效果可能受患者体重指数（BMI）影响；然而，BMI与院内心脏骤停后生存率之间的关系此前尚未得到研究。
方法与结果
我们在国家心肺复苏注册系统（NRCPR）中评估了21237例院内心脏骤停的成年患者。我们通过多变量逻辑回归分析，在按心律类型对心脏骤停进行分层并对患者特征进行校正后，研究了BMI（分类为体重过轻[<18.5kg/m²]、正常[18.5至24.9kg/m²]、超重[25.0至29.9kg/m²]、肥胖[30.0至34.9kg/m²]和极度肥胖[≥35.0kg/m²]）与出院生存率之间的关联。在4499例初始心律为心室颤动或无脉性室性心动过速的患者中，1825例（40.6%）存活至出院。经过多变量校正后，与超重患者相比，体重过轻（比值比[OR]，0.59；95%置信区间[CI]，0.41至0.84；P = 0.003）、正常体重（OR，0.75；95%CI，0.63至0.89；P<0.001）和极度肥胖（OR，0.78；95%CI，0.63至0.96；P = 0.02）患者的生存率较低，而肥胖患者的生存率相似（OR，0.87；95%CI，0.72至1.06；P = 0.17）。相比之下，在16738例因心脏停搏或无脉性电活动导致心脏骤停的患者中，只有2501例（14.9%）存活。经过多变量校正后，除体重过轻患者外（OR，0.67；95%CI，0.54至0.82；P<0.001），所有BMI组的生存率相似。
结论
对于可电击心律导致的心脏骤停，体重过轻、正常体重和极度肥胖患者的出院生存率较低。相比之下，对于不可电击心律导致的心脏骤停，除体重过轻患者外，各BMI组的出院生存率相似。未来需要开展研究以阐明BMI对复苏措施质量和效果的影响程度。
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