肥胖与ICU患者预后的相关性研究

此研究探讨肥胖与ICU患者预后的相关性。方法 选取2022年7月至2023年7月入住皖南医学院第一附属医院EICU的符合纳入标准的患者296例。收集患者临床资料及辅助检查结果,随访至患者院内死亡或者出院后28天。预后指标包括总住院时间,ICU住院时间,机械通气(≥7天),住院死亡率和并发症发生率(气管切开,呼吸机相关性肺炎,肺不张,下肢血栓,中心静脉导管感染,压疮)。根据患者BMI将患者分为肥胖组和非肥胖组,并分析肥胖与患者临床不良事件的相关性。结果 比较两组患者机械通气(≥7天),死亡率,气管切开发生率,压疮发生率,下肢深静脉血栓发生率,中心静脉导管感染率,再次气管插管发生率时,差异无统计学意义(P>0.05)。肥胖组患者呼吸机相关性肺炎及肺不张发生率,ICU住院时间以及总住院时间高于非肥胖组,差异存在计学意义(P<0.05)。进一步行二元Logistic回归分析显示BMI和总住院时间是ICU患者预后的独立危险因素(OR=1.331,95%CI: 1.029~1.722;OR=1.057,95%CI: 1.002~1.115,均P<0.05)。BMI预测肥胖患者发生呼吸机相关性肺炎和肺不张的价值良好,曲线下面积(AUC)分别是0.708,0.727;预测呼吸机相关性肺炎方面最佳截断值为29.04 kg/m2时,灵敏度为58.3%,特异度为79.6%,预测肺不张方面最佳截断值27.94 kg/m2时,灵敏度为77.8%,特异度为63.1%。结论 肥胖不是ICU住院患者死亡的独立危险因素,但肥胖与患者发生呼吸机相关性肺炎和肺不张密切相关;肥胖会延长患者的ICU住院时间和总住院时间。

Clinical features and prognosis of obese breast cancer patients: a retrospective study

Objective:The aim of our study was to investigate the prognosis of obese breast cancer patients.Methods:This study was conducted on a total of 317 breast cancer patients who were histopathologically and clinically diagnosed at the General Hospital of Shenyang Military Region(China)from 2004 to 2006.Clinical data including height,weight,age at diagnosis,tumor size,lymph node status,menopausal status,family history of cancer and hormone receptor status were collected.Log-rank test was performed to compare the disease free survival(DFS)and overall survival(OS).Cox proportional hazards regression analysis was conducted to make multivariate analysis.The Chi square test was used to compare the clinical features among normal weight group,overweight group,and obese group.Results:Obesity was an independent prognostic factor for DFS(P=0.022)and OS(P=0.032)in breast cancer patients.In the stratified analysis based on the hormone receptor status,obesity was independently associated with OS in patients with negative ER/PR(P=0.002),but such association was not observed in patients with positive hormone receptors.Obesity was also associated with lymph node status(P=0.001)and smoking(P=0.009).Conclusion:Obesity is associated with poor DFS and OS in patients with breast cancer.Therefore,maintaining normal weight may benefit breast cancer patients.