Department of Cardiac Science, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Department of Rehabilitation Science, College of Applied Medical Science, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Surgery. 2019 Dec;166(6):1128-1134. doi: 10.1016/j.surg.2019.05.038. Epub 2019 Jul 26.
Coronary artery bypass grafting surgery has an increased risk of adverse events in obese patients. This increased risk might be explained in part by an increased intra-abdominal pressure and the development of intra-abdominal hypertension. Therefore, the objective of this study was to investigate the correlation between obesity and intra-abdominal hypertension and to evaluate its possible impact after coronary artery bypass grafting.
A total of 50 consecutive patients scheduled to undergo coronary artery bypass grafting at a single center were selected prospectively before undergoing elective coronary artery bypass grafting. Based on the body mass index, 25 obese (body mass index ≥ 30) patients were matched with 25 control patients. Each patient had intra-abdominal pressure taken at baseline followed by one measurment every 4 hours until 24 hours after coronary artery bypass grafting. The serum markers for liver and kidney functions were collected once a day for 7 days after coronary artery bypass grafting.
Obese patients had a greater (mean ± SD) peak intra-abdominal pressure (15.4 ± 1.6 mm Hg versus 10.6 ± 1.6 mm Hg; P = .011) and mean change of intra-abdominal pressure from baseline (5.1 ± 3.3 mm Hg versus 2.2 ± 2.4 mm Hg; P = .001). The mean abdominal perfusion pressure was less in the obese group (63.0 ± 8.0 mm Hg versus 70.1 ± 11 mm Hg; P = .017). The liver dysfunction, as determined by the Schindl liver function scoring system between the obese and control groups, was not statistically significant (28% vs 8%; P = .066). More patients in the obese group developed renal injury based on the calculated glomerular filtration rate (32% vs 8%; P = .034). Obesity was highly associated with developing intra-abdominal hypertension (odds ratio: 2.99; 95% confidence interval: 1.92-3.53; P < .001).
Obesity is associated with the development of intra-abdominal hypertension after coronary artery bypass grafting. This effect might indirectly impair the renal and liver functions through a decrease in the abdominal perfusion pressure.
冠状动脉旁路移植术在肥胖患者中发生不良事件的风险增加。这种风险的增加可能部分归因于腹内压增加和腹内高压的发展。因此，本研究的目的是探讨肥胖与腹内高压的相关性，并评估其在冠状动脉旁路移植术后的可能影响。
前瞻性选择在单一中心接受择期冠状动脉旁路移植术的 50 例连续患者。根据体重指数，将 25 例肥胖（体重指数≥30）患者与 25 例对照患者匹配。每位患者在基线时测量一次腹内压，然后每 4 小时测量一次，直到冠状动脉旁路移植术后 24 小时。冠状动脉旁路移植术后第 7 天，每天采集一次肝功能和肾功能的血清标志物。
肥胖患者的峰值腹内压（15.4±1.6mmHg 比 10.6±1.6mmHg；P=.011）和基线时腹内压的平均变化（5.1±3.3mmHg 比 2.2±2.4mmHg；P=.001）均较高。肥胖组的平均腹主动脉灌注压较低（63.0±8.0mmHg 比 70.1±11mmHg；P=.017）。肥胖组和对照组之间的 Schindl 肝功能评分系统确定的肝功能障碍无统计学意义（28%比 8%；P=.066）。根据计算的肾小球滤过率，肥胖组有更多的患者发生肾损伤（32%比 8%；P=.034）。肥胖与发生腹内高压高度相关（比值比：2.99；95%置信区间：1.92-3.53；P<.001）。
肥胖与冠状动脉旁路移植术后腹内高压的发生有关。这种影响可能通过降低腹主动脉灌注压间接损害肝肾功能。
