Obesity and traumatic brain injury
Obesity and traumatic brain injury
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DOI：
10.1097/01.ta.0000200842.19740.38
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发表时间：
2006-09-01
影响因子：
--
通讯作者：
Demetriades, Demetrios
中科院分区：
文献类型：
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作者：
Brown, Carlos V. R.;Rhee, Peter;Demetriades, Demetrios
背景：随着肥胖在我们的社会中继续猖獗，对创伤性损伤后其不良影响的理解开始展开。我们假设，肥胖的负面影响头部受伤的患者，目前的研究旨在比较肥胖和瘦患者与创伤性脑损伤（TBI）：这是一项回顾性研究，评估所有钝性创伤患者TBI入住重症监护室（ICU）在我们的城市，一级创伤中心，从1998年到2003年。使用体重指数（BMI）将患者分为瘦型（BMI < 30 kg/m2）或肥胖型（BMI >= 30 kg/m2）。记录每例患者的入院人口统计学资料、头部损伤的类型和严重程度以及相关损伤。主要结局是死亡率，次要结局是死亡原因、并发症，对于幸存者，是机械通气天数、ICU住院时间和住院时间。采用单因素分析和多因素逐步Logistic回归分析比较肥胖和瘦型患者。结果：在研究期间，有690名TBI患者入住ICU，其中129名（19%）肥胖患者（BMI = 34 +/- 5 kg/m2）和561名（81%）消瘦患者（BMI = 24 +/- 4 kg/m2）。两组相似，除了肥胖患者年龄较大（46 +/- 20岁vs 39岁，p < 0.01），入院时收缩压较低（125 +/- 38 mm Hg vs 134 +/- 30 mm Hg，p = 0.01），并且更常发生相关的胸部损伤（46% vs 35%，p = 0.03）。患有TBI的肥胖患者有出现更多并发症（34%与28%，p = 0.17）和更高死亡率（36%与25%，p = 0.02）的趋势。然而，逐步逻辑回归未能确定肥胖作为一个独立的危险因素，无论是发病率或死亡率。此外，肥胖患者孤立性脑损伤并发症或death.Conclusions：虽然肥胖患者遭受更多的并发症和更高的死亡率比瘦患者TBI后，这种不良影响似乎是由于年龄，入院血压较低，更相关的胸部损伤，而不是肥胖状态的直接结果。
Background: As obesity continues to run rampant in our society, an understanding of its adverse effect after traumatic injury is starting to unfold. We hypothesize that obesity negatively impacts head-injured patients, and the current study intends to compare obese and lean patients with traumatic brain injury (TBI).Methods: This is a retrospective study evaluating all blunt trauma patients with TBI admitted to the intensive care unit (ICU) in our urban, Level I trauma center from 1998 until 2003. Body mass index (BMI) was used to categorize patients as either lean (BMI < 30 kg/m(2)) or obese (BMI >= 30 kg/m(2)). Admission demographics, type and severity of head injury, and associated injuries were recorded for each patient. Primary outcome was mortality, while secondary outcomes were cause of death, complications, and for survivors, days of mechanical ventilation, ICU length of stay, and hospital length of stay. Obese and lean patients were compared using univariate analysis and multivariate stepwise logistic regression. In addition, a subgroup analysis of patients with isolated head injury was performed.Results:There were 690 patients with TBI admitted to the ICU during the study period, with 129 (19%) obese patients (BMI = 34 +/- 5 kg/m(2)) and 561 (81%) lean patients (BMI = 24 +/- 4 kg/m(2)). The two groups were similar with the exceptions that obese patients were older (46 +/- 20 years versus 39 years, p < 0.01), had lower admission systolic blood pressure (125 +/- 38 mm Hg versus 134 +/- 30 mm Hg,p = 0.01), and more often sustained an associated chest injury (46% versus 35%, p = 0.03). Obese patients with TBI had a trend toward more complications (34% versus 28%, p = 0.17) and a higher mortality (36% versus 25%, p = 0.02). However, stepwise logistic regression failed to identify obesity as an independent risk factor for either morbidity or mortality. In addition, obese patients with isolated head injury had no increase in complications or death.Conclusions: Although obese patients suffer more complications and higher mortality than lean patients after TBI, this adverse effect seems to be due to age, lower admission blood pressure, and more associated chest injury, rather than a direct result of the obese state.