Özgür Yasemin, Akın Seydahmet
University of Health Sciences Kartal Dr. Lutfi Kırdar Training and Research Hospital Internal Medicine Istanbul Turkey.
J Acute Med. 2021 Jun 1;11(2):49-62. doi: 10.6705/j.jacme.202106_11(2).0002.
Previous studies conducted on critical patients in intensive care units have shown that fluid balance disorder (FBD) increases mortality. The purpose of this study is to investigate the effect of FBD on mortality of patients hospitalized in internal medicine ward.
The present study was designed as an observational study and follow-up period of the patients began in the first 8 hours of admission to the emergency room who had hypervolemia findings in physical examination were included in the fluid balance FB (+) group; those who had any of the dehydration findings were included in FB (-) group, those who had both hypervolemia and dehydration findings were included in FB (mix) group, and those with normal examination findings were included in FB (N) group.
A total of 303 patients, mean age of 66.4 ± 15.9 years, 54.5% male, were included in the study, which covered the period between May 1, 2019 and September 30, 2019. In-hospital, monthly and quarterly cumulative survival rates of the patients were respectively; 91.7 ± 2.7%, 89.2 ± 2.8%, 81.7 ± 3.5% in FB (N) group; 86.3 ± 5.2%, 82.2 ± 5.7%, and 57.8 ± 7.4% in FB (-) group; 70.9 ± 4.4%, 68.1 ±4.4%, and 54.9 ± 4.7% in FB (+) group; 57.6 ± 10.2%, 56.0 ± 9.9%, 44.0 ± 9.9% in FB (mix) group. It was determined that there was an approximately 3-fold increase in both monthly and quarterly mortality risks in those who had FBD compared to those who were not (HR: 3.077 and 3.031, respectively). It was shown with the multivariate Cox regression analyses that this risk increases independently from both preliminary diagnosis, concomitant diseases, vital disorders (30-day and 90-day AHR 2.541 and 2.517, respectively), and from the biochemical disorders (30-day and 90-day AHR 2.132 and 2.124, respectively).
Our study is important in terms of emphasizing the value of physical examination which lost its popularity with the development of technology and many medical instruments, but still simple and cheap.
先前针对重症监护病房中的重症患者进行的研究表明，液体平衡紊乱（FBD）会增加死亡率。本研究的目的是调查FBD对内科病房住院患者死亡率的影响。
本研究设计为一项观察性研究，患者的随访期从急诊室入院的前8小时开始，体格检查有血容量过多表现的患者被纳入液体平衡FB（+）组；有任何脱水表现的患者被纳入FB（-）组，既有血容量过多又有脱水表现的患者被纳入FB（混合）组，体格检查结果正常的患者被纳入FB（N）组。
本研究共纳入303例患者，平均年龄66.4±15.9岁，男性占54.5%，研究涵盖2019年5月1日至2019年9月30日期间。患者的院内、月度和季度累积生存率分别为：FB（N）组91.7±2.7%、89.2±2.8%、81.7±3.5%；FB（-）组86.3±5.2%、82.2±5.7%、57.8±7.4%；FB（+）组70.9±4.4%、68.1±4.4%、54.9±4.7%；FB（混合）组57.6±10.2%、56.0±9.9%、44.0±9.9%。结果发现，与没有FBD的患者相比，有FBD的患者月度和季度死亡风险均增加了约3倍（HR分别为3.077和3.031）。多变量Cox回归分析表明，这种风险独立于初步诊断、合并疾病、生命紊乱（30天和90天AHR分别为2.541和2.517）以及生化紊乱（30天和90天AHR分别为2.132和2.124）而增加。
我们的研究强调了体格检查的价值，这一点很重要。随着技术和许多医疗仪器的发展，体格检查已不再那么受欢迎，但它仍然简单且廉价。
