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引用本文:Diane M. Dennis Chrianna Bharat Timothy Paterson.肥胖患病率及其对患者机械通气时间和在重症监护室住院时间的影响:单中心观察研究[J].中国护理管理,2017,17(5):720 本文二维码信息
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肥胖患病率及其对患者机械通气时间和在重症监护室住院时间的影响:单中心观察研究
Prevalence of obesity and the effect on length of mechanical ventilation and length of stay in intensive care patients: a single site observational study
  
DOI:
中文关键词:  身体质量指数  重症监护  住院时间  肥胖
English Keywords:Body Mass Index  critical care  length of stay  obesity
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作者单位
Diane M. Dennis Chrianna Bharat Timothy Paterson 澳大利亚 Sir Charles Gairdner医院重症监护室(Diane M. DennisTimothy Paterson)澳大利亚西澳大利亚大学应用统计中心, 澳大利亚 Sir Charles Gairdner医院研究部(Chrianna Bharat) 
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中文摘要:
      目的:在重症监护室(ICU)患者样本中,为异常身体质量指数(BMI)的发生率提供概况;确定是否有任一医学专科与异常的BMI有关;分析BMI与ICU相关转归的关联。方法:选择2012年11月至2014年6月,在Sir Charles Gairdner医院的三级ICU(23张床位)住院的735例成年患者(年龄中位数为58岁),进行回顾性观察。首要结果测量指标是患者的BMI,低体质量(<18.5 kg/m2)、正常体质量(18.5~24.99 kg/m2)、超重(25~29.99 kg/m2)、肥胖(30~39.99 kg/m2)或重度肥胖(≥40 kg/m2);其他测量指标包括性别、急性生理学与慢性健康状况评分系统Ⅱ评分、住院科室、机械通气(MV)时间、住院时间(LOS)和病死率。结果:与普通人群比较,研究队列中肥胖患者的比例更高,绝大部分患者超重(33.9%)或肥胖(36.5%),BMI的中位数为27.9(IQR为7.9)。不同专科患者的BMI无统计学差异(P=0.103)。未发现异常BMI对患者病死率有负面影响(ICU,P=0.373;医院,P=0.330);正常BMI患者比其他类型BMI患者的MV时间更短,BMI对患者ICU LOS的影响取决于MV时间。与正常体质量的患者比较,机械通气时间为5天或更长的超重患者,LOS更短;重度肥胖无机械通气的患者,LOS更长。结论:尽管肥胖-疾病关系日益复杂化,而现有数据只反映了单中心ICU住院患者的不同类别的BMI;但在研究队列中,考虑护理的成本影响仍然可能是重要的,尤其是对MV和LOS的影响。
English Summary:
      Objective: To provide a snapshot of the prevalence of abnormal body mass index (BMI) in a sample of Intensive Care Unit (ICU) patients; to identify if any medical specialty was associated with abnormal BMI and to explore associations between BMI and ICU-related outcomes. Methods: Retrospective observational audit of 735 adult patients (median age 58 years) admitted to the Sir Charles Gairdner Hospital 23 bed tertiary ICU between November 2012 and June 2014. Primary outcome measure was patient BMI: underweight (<18.5 kg/m2), normal weight (18.5–24.99 kg/m2), overweight (25–29.99 kg/m2), obese (30–39.99 kg/m2) or extreme obese (40 kg/m2 or above). Other measures included gender, acute physiology and chronic health evaluation II score, admission specialty, length of Mechanical Ventilation (MV), Length of Stay (LOS) and mortality. Results: Compared to the general population there was a higher proportion of obese patients within the cohort with the majority of patients overweight (33.9%) or obese (36.5%) and median BMI of 27.9 (IQR 7.9). There were no significant differences between specialties for BMI (P=0.103) and abnormal BMI was not found to impact negatively on mortality (ICU, P=0.373; hospital, P=0.330). Normal BMI patients had shorter length of MV than other BMI categories and the impact of BMI on ICU LOS was dependent on length of MV. Overweight patients ventilated for five days or more had a shorter LOS, and extremely obese non-ventilated patients had a longer LOS, compared to normal weight patients. Conclusion: Although the obesity–disease relationship is increasingly complex and data presented reflects categorical BMI for patients admitted to a single ICU site it may be important to consider the cost implications of caring for this cohort especially with regard to MV and LOS.
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