Le-Bert George, Santana Orlando, Pineda Andrés M, Zamora Carlos, Lamas Gervasio A, Lamelas Joseph
Division of Cardiology at Mount Sinai Medical Center, Columbia University, Miami Beach, FL 33140, USA.
Interact Cardiovasc Thorac Surg. 2011 Aug;13(2):124-7. doi: 10.1510/icvts.2010.256677. Epub 2011 May 4.
We sought to determine whether the protective role of the 'obesity paradox' was present among elderly obese patients undergoing coronary artery bypass grafting (CABG) by median sternotomy. We retrospectively analyzed 1909 consecutive patients who underwent heart surgery between January 2006 and June 2009, and identified 396 patients who were ≥ 70 years of age and had isolated CABG. Subjects were divided into three groups according to their body mass index (BMI): obese (BMI ≥ 30 kg/m(2)), overweight (BMI 25-29.99 kg/m(2)) and normal (BMI 18.5-24.99 kg/m(2)). Of the 396 patients, 94 were obese, 167 were overweight, and 135 had a normal BMI. The composite of in-hospital complications and hospital mortality did not differ between the groups. Re-exploration for bleeding was required in none of the obese patients, which was statistically significant (P=0.05) compared to the other groups; otherwise there was no statistical difference for all other complications, including total length hospital stay and length of stay in the intensive care unit. Despite being labeled as higher risk candidates preoperatively, obese elderly patients undergoing CABG did not demonstrate an increased risk of postsurgical complications. We conclude that the 'obesity paradox' is present in this population, and they should not be excluded from receiving the benefits of CABG.
我们试图确定在接受正中胸骨切开冠状动脉搭桥术（CABG）的老年肥胖患者中，“肥胖悖论”的保护作用是否存在。我们回顾性分析了2006年1月至2009年6月期间连续接受心脏手术的1909例患者，并确定了396例年龄≥70岁且仅接受CABG的患者。根据体重指数（BMI）将受试者分为三组：肥胖（BMI≥30kg/m²）、超重（BMI 25-29.99kg/m²）和正常（BMI 18.5-24.99kg/m²）。在这396例患者中，94例为肥胖患者，167例为超重患者，135例BMI正常。各组之间的院内并发症和住院死亡率的综合情况没有差异。没有肥胖患者需要因出血而再次手术，与其他组相比具有统计学意义（P=0.05）；否则，包括总住院时间和重症监护病房住院时间在内的所有其他并发症均无统计学差异。尽管术前被列为高风险候选者，但接受CABG的肥胖老年患者术后并发症风险并未增加。我们得出结论，该人群中存在“肥胖悖论”，不应将他们排除在接受CABG益处之外。
