体重指数对机器人心脏手术后临床结局的影响：是否存在肥胖悖论？
Effect of body mass index on clinical outcomes after robotic cardiac surgery: is there an obesity paradox?
机构信息
Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Road, Yuzhong District, Chongqing, 400042, P.R. China.
出版信息
BMC Cardiovasc Disord. 2023 May 23;23(1):271. doi: 10.1186/s12872-023-03277-w.
BACKGROUND
To investigate the effect of body mass index (BMI) on clinical outcomes after robotic cardiac surgery, and to explore the postoperative obesity paradox.
METHODS
The data of 146 patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed, and their demographic data and related clinical data were statistically analyzed. The mean age was (42.88 ± 13.01) years, 55 (37.67%) were male and 91 (62.33%) were female. Patients were divided into 3 groups according to preoperative BMI: lean group (BMI < 18.5 kg/m; n = 17; 11.64%), normal group (BMI 18.5 kg/m to 23.9 kg/m; n = 81; 55.48%), and overweight and obese group (BMI ≥ 24 kg/m; n = 48; 32.88%). Multivariate analysis was performed to compare clinical outcomes across BMI groups.
RESULTS
Preoperative data in different BMI groups showed that there were statistically significant differences in age, height, weight, body surface area (BSA), diabetes, left atrial anteroposterior diameter (LAD), triglyceride (TG), and high-density lipoprotein (HDL) (all P < 0.05). Postoperative clinical outcomes showed that there was no statistical difference between the lean group and the normal group; the intensive care unit stay and postoperative hospital stay in the overweight and obese group were significantly higher than those in the normal group (P < 0.05), and the risk of postoperative cardiac surgery-related acute kidney injury (CSA-AKI) was significantly increased (P = 0.021); further Multiple Binary Logistic Regression Analysis suggested that preoperative TG (OR = 1.772, 95% CI 1.068-2.942, P = 0.027) and operation time ≥ 300 min (OR = 3.823, 95% CI 1.098-13.308, P = 0.035) were independent risk factors for postoperative CSA-AKI.
CONCLUSIONS
Overweight and obese patients had significantly prolonged intensive care unit stay and postoperative hospital stay after robotic cardiac surgery, and significantly increased incidence of postoperative CSA-AKI, which did not support the obesity paradox; preoperative TG and operation time ≥ 300 min were independent risk factors for postoperative CSA-AKI.
背景
探讨体重指数（BMI）对机器人心脏手术后临床结局的影响，并探讨术后肥胖悖论。
方法
回顾性分析 2016 年 7 月至 2022 年 6 月在陆军军医大学大坪医院行体外循环（CPB）下机器人心脏手术的 146 例患者的临床资料，对其人口统计学数据和相关临床资料进行统计学分析。患者平均年龄为（42.88±13.01）岁，其中男性 55 例（37.67%），女性 91 例（62.33%）。根据术前 BMI 将患者分为 3 组：消瘦组（BMI＜18.5 kg/m；n=17；11.64%）、正常组（BMI 18.5~23.9 kg/m；n=81；55.48%）和超重肥胖组（BMI≥24 kg/m；n=48；32.88%）。采用多变量分析比较 BMI 组之间的临床结局。
结果
不同 BMI 组的术前数据显示，年龄、身高、体重、体表面积（BSA）、糖尿病、左心房前后径（LAD）、甘油三酯（TG）和高密度脂蛋白（HDL）差异有统计学意义（均 P＜0.05）。术后临床结果显示，消瘦组和正常组之间无统计学差异；超重肥胖组的重症监护病房停留时间和术后住院时间明显高于正常组（P＜0.05），且术后心脏手术相关急性肾损伤（CSA-AKI）风险明显增加（P=0.021）；进一步的多因素二项逻辑回归分析表明，术前 TG（OR=1.772，95%CI 1.0682.942，P=0.027）和手术时间≥300 min（OR=3.823，95%CI 1.09813.308，P=0.035）是术后 CSA-AKI 的独立危险因素。
结论
超重肥胖患者行机器人心脏手术后重症监护病房停留时间和术后住院时间明显延长，术后 CSA-AKI 发生率明显增加，不支持肥胖悖论；术前 TG 和手术时间≥300 min 是术后 CSA-AKI 的独立危险因素。
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