Ferro Tammy N, Goslar Pamela W, Romanovsky Andrej A, Petersen Scott R
Department of Internal Medicine, Banner Good Samaritan Hospital, Phoenix, Arizona, USA.
J Trauma. 2010 Aug;69(2):308-12. doi: 10.1097/TA.0b013e3181e1761e.
There is a high percentage of smokers among trauma patients. Cigarette smoking has been associated with the development of acute lung injury and the adult respiratory distress syndrome in critically ill patients. It is also known that nicotine exerts immunosuppressive and anti-inflammatory effects with chronic use. Trauma patients who are smokers usually go through acute nicotine withdrawal after the traumatic event and during their stay in ICU. How the smoking status and acute nicotine withdrawal affect outcomes after trauma is unknown. This question was addressed in this study by analyzing the incidence of sepsis, septic shock and multiple organ dysfunction syndrome, and other outcomes in smoking and nonsmoking trauma patients.
A retrospective cohort of trauma patients who met the criteria was randomly selected from the trauma registry. Individual charts were reviewed to confirm documented smoking status. Criteria for selection included the following: Injury Severity Score >or=20, age 18 to 65 years, hospital length of stay >72 hours. Patients with COPD/emphysema, diabetes mellitus, cardiac disease, malignancy, pregnancy, or steroid use were excluded.
Overall, 327 patient charts were reviewed: 156 smokers and 171 nonsmokers. Men outnumbered women in the smoking group fourfold (p = 0.003 versus nonsmokers). Age, Injury Severity Score, the presence of shock on admission, the type of trauma (blunt or penetrating), ICU and hospital length of stay, and the duration of ventilator support were similar between smokers and nonsmokers. There were no differences in the incidence of sepsis, pneumonia, adult respiratory distress syndrome, or multiple organ dysfunction syndrome. Mortality was low (1.2% in smokers; 0.6% in nonsmokers) and did not differ significantly between the groups.
The smoking status plays a minimal role in the outcome of healthy trauma patients. This suggests that the acute nicotine withdrawal that usually occurs in critically ill patients has no clinically significant implications after injury.
创伤患者中吸烟者比例较高。吸烟与危重症患者急性肺损伤及成人呼吸窘迫综合征的发生有关。众所周知，长期使用尼古丁会产生免疫抑制和抗炎作用。吸烟的创伤患者在创伤事件后及入住重症监护病房期间通常会经历急性尼古丁戒断。吸烟状态和急性尼古丁戒断如何影响创伤后的结局尚不清楚。本研究通过分析脓毒症、感染性休克和多器官功能障碍综合征的发生率以及吸烟和不吸烟创伤患者的其他结局来探讨这个问题。
从创伤登记处随机选取符合标准的创伤患者回顾性队列。查阅个体病历以确认记录的吸烟状态。入选标准包括：损伤严重度评分≥20、年龄18至65岁、住院时间>72小时。排除慢性阻塞性肺疾病/肺气肿、糖尿病、心脏病、恶性肿瘤、妊娠或使用类固醇的患者。
总体而言，共查阅了327份患者病历：156名吸烟者和171名不吸烟者。吸烟组男性人数是女性的四倍（与不吸烟者相比，p = 0.003）。吸烟者和不吸烟者在年龄、损伤严重度评分、入院时是否存在休克、创伤类型（钝性或穿透性）、重症监护病房和住院时间以及机械通气支持时间方面相似。脓毒症、肺炎、成人呼吸窘迫综合征或多器官功能障碍综合征的发生率无差异。死亡率较低（吸烟者为1.2%；不吸烟者为0.6%），两组间无显著差异。
吸烟状态对健康创伤患者的结局影响极小。这表明危重症患者中通常发生的急性尼古丁戒断在受伤后没有临床显著影响。
