"Smoker's Paradox" in Patients Treated for Severe Injuries: Lower Risk of Mortality After Trauma Observed in Current Smokers.
"Smoker's Paradox" in Patients Treated for Severe Injuries: Lower Risk of Mortality After Trauma Observed in Current Smokers.
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接受严重损伤治疗的患者的“吸烟者悖论”：在当前吸烟者中观察到的创伤后死亡风险较低。
DOI：
10.1093/ntr/ntv027
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Zarzaur,BenL
中科院分区：
文献类型：
--
作者：
Bell,TeresaM;Bayt,DemetriaR;Zarzaur,BenL
背景 尽管在其他重症监护机构中已经报道了吸烟对生存的益处，但评估吸烟状况对创伤患者死亡率影响的研究仍然有限。 “吸烟者悖论”现象是指在发生急性心血管事件（例如急性心肌梗死和心脏骤停）后，吸烟者在医院的死亡率通常会降低。我们研究的目的是确定吸烟是否会给创伤性损伤患者带来生存获益。方法我们进行了一项回顾性队列研究，分析了国家创伤数据库研究数据集中的病例。使用分层逻辑回归分析来确定吸烟是否会改变吸烟患者的死亡和并发症风险。结果吸烟者 (n= 38,564) 和非吸烟者 (n= 319,249) 之间经历死亡的患者百分比存在显着差异（1.8% vs. 4.3%，P< .001）；然而，出现严重并发症的百分比却没有出现（9.7% vs. 9.6%，P= 0.763）。回归分析表明，在调整个人和医院因素后，与不吸烟者相比，吸烟者在住院期间死亡的可能性显着降低（OR = 0.15；CI = 0.10，0.22）。此外，与不吸烟者相比，吸烟者发生主要并发症的可能性也较小（OR = 0.73，CI = 0.59–0.91）。 结论 吸烟患者的院内死亡风险似乎比不吸烟者低得多。应进一步研究造成这种效应的生物学机制，以便潜在地开发治疗应用。
BackgroundStudies evaluating the effect of smoking status on mortality outcomes in trauma patients have been limited, despite the fact that survival benefits of smoking have been reported in other critical care settings. The phenomenon “smoker’s paradox” refers to the observation that following acute cardiovascular events, such as acute myocardial infarction and cardiac arrest, smokers often experience decreased mortality in the hospital setting. The objective of our study was to determine whether smoking imparts a survival benefit in patients with traumatic injuries.MethodsWe performed a retrospective cohort study that analyzed cases included in the National Trauma Data Bank research dataset. Hierarchical logistic regression analyses were used to determine whether smoking alters the risk of mortality and complications in patients who smoke.ResultsThe percentage of patients experiencing mortality differed significantly between smokers (n= 38,564) and nonsmokers (n= 319,249) (1.8% vs. 4.3%,P< .001); however, the percentage experiencing a major complication did not (9.7% vs. 9.6%,P= .763). Regression analyses indicated that smokers were significantly less likely to die during the hospital stay compared to nonsmokers after adjusting for individual and hospital factors (OR= 0.15; CI = 0.10, 0.22). Additionally, smokers were also less likely to develop a major complication than nonsmokers (OR= 0.73, CI = 0.59–0.91).ConclusionsPatients who smoke appear to have a much lower risk of in-hospital mortality than nonsmokers. Further investigation into biological mechanisms responsible for this effect should be carried out in order to potentially develop therapeutic applications.
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DOI：
10.1177/107602960401000314
发表时间：
2004
期刊：
Clinical and Applied Thrombosis/Hemostasis
影响因子：
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