摘要目的 通过分析严重创伤患者早期体重变化趋势及与预后的关系,探讨早期动态体重监测在严重创伤救治中的意义. 方法 采用前瞻性队列研究分析2015年6月-2015年12月收治的65例严重创伤患者的临床资料,其中男41例,女24例;年龄(54±17)岁.入急诊ICU(EICU)时的体重指数(BMI)为(22.0±2.7) kg/m2,损伤严重度评分(ISS)为(22±5)分,急性生理与慢性健康评估Ⅱ(APACHE Ⅱ)评分为(15±6)分.依据患者预后分为生存组(56例)和死亡组(9例).每日进行体重监测并收集数据,评估两组患者每天体重变化的差异.评估体重变化与容量变化间的关系及每天体重变化趋势与预后的关系. 结果 两组患者1周内体重变化以负性变化趋势为主.住院期间死亡组和生存组体重变化分别为0.4(0.2,0.8)kg和-0.2(-0.7,0.2)kg(P＜0.01).两组1周内累计体重变化差异有统计学意义,体重累计增加值相差5.02 kg(95％ CI3.97～ 6.07,P＜0.01).患者1周内每天体重的变化与每天液体进出量的变化有较好的相关性(r =0.69,P＜0.01).Logistic回归分析提示1周内每天体重增加会提高创伤患者住院的病死率(OR=3.05,P＜0.05). 结论 严重创伤患者入EICU早期体重变化呈负性变化趋势.患者入EICU的1周内每天体重的变化与每天液体进出量的变化有较好的相关性.体重增加可能会增加患者的住院病死率.

abstractsObjective To investigate the association between body weight daily fluctuation and prognosis in severe trauma patients and evaluate the values of dynamical monitoring of early weight change in treatment of severe trauma.Methods A prospective cohort study was made on 65 patients with severe trauma treated between June 2015 and December 2015.There were 41 males and 24 females,with age of (54 ± 17)years.When admitted to the emergency intensive care unit (EICU),the patients were with body mass index (BMI) for (22.0 ±2.7) kg/m2,injury severity score (ISS) for (22 ±5) points,as well as acute physiology and chronic health evaluation (APACHE) Ⅱ for (15 ± 6)points.According to the survival status during hospitalization,the patients were distributed to death group (9 patients) and survival group (56 patients).Daily body weight was measured from admission by using a weighing scale to evaluate the difference of daily body weight change between two groups.The correlation between daily body weight change and volume change as well as the relationship between daily body weight change tendency and prognosis were evaluated.Results Overall,the variation of weight was negatively correlated with ICU stay in two groups.The weight variations in death group and survival group were 0.4 (0.2,0.8) kg and-0.2 (-0.7,0.2) kg,respectively (P ＜ 0.01).The cumulative weight variation between two groups within one week was 5.02 kg (95％ CI 3.97-6.07,P ＜0.01).The change of body weight was moderately correlated with corresponding fluid balance (r =0.69,P ＜ 0.01).According to the Logistic regression analysis,daily weight gain within one week was found to be positively associated with ICU mortality (OR =3.05,P ＜ 0.05).Conclusions The body weight is negatively correlated with ICU stay in severe trauma patients.The body weight change within one week in EICU is closely correlated with fluid balance and body weight increase may elevate the risk of ICU mortality.