Kindo Michel, Minh Tam Hoang, Gerelli Sébastien, Meyer Nicolas, Schaeffer Mickaël, Perrier Stéphanie, Bentz Jonathan, Announe Tarek, Mommerot Arnaud, Collange Olivier, Marguerite Sandrine, Thibaud Adrien, Gros Hubert, Billaud Philippe, Mazzucotelli Jean-Philippe
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Department of Cardiovascular Surgery, University Hospitals of Strasbourg, France.
Thromb Res. 2014 Aug;134(2):346-53. doi: 10.1016/j.thromres.2014.06.008. Epub 2014 Jun 12.
Obesity is suggested to reduce postoperative bleeding in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) but perioperative hemostasis variations have not been studied. Therefore, we investigated the effects of severe obesity (body mass index [BMI] ≥35kg/m(2)) on chest tube output (CTO) and hemostasis in patients undergoing cardiac surgery with CPB.
We prospectively investigated 2799 consecutive patients who underwent coronary and/or valve surgery using CPB between 2008 and 2012. 204 patients (7.3%) presented a severe obesity.
In the severe obesity group, the 6-h and 24-h CTO were significantly reduced by -21.8% and -14.8% respectively (P<0.0001) compared with the control group. A significant reduction of the mean number of red blood cell units transfused at 24h was observed in the severe obesity groups (P=0.01). On admission to the intensive care unit, a significant increase of platelet count (+9.2%; P<0.0001), fibrinogen level (+12.2%; P<0.0001) and prothrombin time (+4.1%; P<0.01) and a significant decrease of the activated partial thromboplastin time (-4.2%; P<0.01) were observed in the severe obesity group compared with the control group. In multivariate analysis, severe obesity was significantly associated to a decreased risk of excessive bleeding (24-h CTO >90th percentile; Odds ratio: 0.37, 95% CI: 0.17 to 0.82). No significant differences were observed regarding postoperative thromboembolic events between the two groups.
Severe obesity is associated with a prothrombotic postoperative state that leads to a reduction of postoperative blood loss in patients undergoing cardiac surgery with CPB.
有研究表明，肥胖可减少接受体外循环（CPB）心脏手术患者的术后出血，但围手术期止血的变化尚未得到研究。因此，我们研究了严重肥胖（体重指数[BMI]≥35kg/m²）对接受CPB心脏手术患者胸管引流量（CTO）和止血的影响。
我们前瞻性地研究了2008年至2012年间连续接受CPB冠状动脉和/或瓣膜手术的2799例患者。其中204例患者（7.3%）为严重肥胖。
与对照组相比，严重肥胖组6小时和24小时的CTO分别显著降低了21.8%和14.8%（P<0.0001）。严重肥胖组24小时输注红细胞单位的平均数显著减少（P=0.01）。与对照组相比，严重肥胖组在进入重症监护病房时，血小板计数显著增加（+9.2%；P<0.0001）、纤维蛋白原水平显著增加（+12.2%；P<0.0001）、凝血酶原时间显著增加（+4.1%；P<0.01），活化部分凝血活酶时间显著缩短（-4.2%；P<0.01）。多因素分析显示，严重肥胖与出血过多风险降低显著相关（24小时CTO>第90百分位数；优势比：0.37，95%可信区间：0.17至0.82）。两组术后血栓栓塞事件无显著差异。
严重肥胖与血栓形成的术后状态相关，这导致接受CPB心脏手术的患者术后失血减少。
