Department of Cardiovascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
Department of Cardiovascular Surgery, Changhai Hospital, Navy Medical University, Shanghai, China.
Heart Lung Circ. 2020 Nov;29(11):1725-1732. doi: 10.1016/j.hlc.2020.02.008. Epub 2020 Mar 19.
In recent years, obese patients presenting with acute thoracic aortic dissection have not been uncommon and there are often pulmonary complications among them. Whether a higher body mass index (BMI) is associated with more pulmonary complications or even a higher mortality rate has yet to be determined. This study aimed to evaluate the effects of higher BMI on pulmonary complications and other surgical outcomes.
A total of 404 patients who underwent acute thoracic aortic dissection surgery were retrospectively studied. They were divided into three groups based on their BMI: normal weight (BMI 18.5 to <25 kg/m, n=173), overweight (BMI 25 to <30 kg/m, n=145) and obese (BMI ≥30 kg/m, n=86). Clinical data were collected and analysed among groups.
No statistical significance was detected among the groups for postoperative complications, in-hospital mortality and hospital or ICU stay, except for prolonged intubation, the proportion of which was highest in the obese group followed by the overweight and normal groups (40.7% vs 29% vs 11%, respectively; p<0.001). Furthermore, logistic regression analysis showed that postoperative renal failure (OR=16.984) and cardiopulmonary bypass time (OR=1.013) were independent risk factors for in-hospital mortality, while higher BMI (OR=7.148 for BMI ≥25 and 18.967 for BMI ≥30), transfused red blood cells (OR=1.004), and postoperative renal failure (OR=7.386) were independent risk factors for prolonged ventilation (p<0.05).
Body mass index had no effect on in-hospital mortality but may be closely correlated with prolonged intubation for patients undergoing aortic dissection surgery. This finding suggests that these patients should receive more aggressive pulmonary management.
近年来，肥胖患者合并急性胸主动脉夹层并不少见，且常合并肺部并发症。较高的体重指数（BMI）是否与更多的肺部并发症甚至更高的死亡率相关，目前尚未确定。本研究旨在评估较高 BMI 对肺部并发症和其他手术结果的影响。
回顾性分析 404 例急性胸主动脉夹层手术患者的临床资料，根据 BMI 将其分为三组：正常体重组（BMI18.5<25kg/m²，n=173）、超重组（BMI25<30kg/m²，n=145）和肥胖组（BMI≥30kg/m²，n=86）。比较各组间的临床资料。
术后并发症、院内死亡率、住院时间和 ICU 住院时间在三组间无统计学差异，仅机械通气时间延长在肥胖组中比例最高，其次是超重组和正常体重组（40.7%、29%、11%，p<0.001）。Logistic 回归分析显示，术后肾衰竭（OR=16.984）和体外循环时间（OR=1.013）是院内死亡的独立危险因素，而较高 BMI（OR=7.148 对于 BMI≥25 和 18.967 对于 BMI≥30）、输血量（OR=1.004）和术后肾衰竭（OR=7.386）是机械通气时间延长的独立危险因素（p<0.05）。
BMI 对院内死亡率无影响，但与主动脉夹层手术后患者的机械通气时间延长密切相关。这一发现提示这些患者应接受更积极的肺部管理。
