肌肉减少症对老年患者体外循环心脏手术后术后恢复的影响。

Effects of sarcopenia on postoperative recovery in elderly patients after cardiac surgery with cardiopulmonary bypass.

作者信息

Wang Xiaoqian, Wang Zhen, Cheng Yongqing, Chen Xiaotian

机构信息

Department of Clinical Nutrition, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.

Department of Cardiac Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.

出版信息

BMC Geriatr. 2025 Apr 30;25(1):295. doi: 10.1186/s12877-025-05966-x.

DOI:10.1186/s12877-025-05966-x

PMID:40307687

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12042521/

Abstract

BACKGROUND

Few studies have assessed sarcopenia identified by erector spinae muscle (ESM) using thoracic computed tomography (CT) before cardiac surgery. We aimed to explore the relationship between sarcopenia evaluated via ESM and poor outcomes following cardiac surgery with cardiopulmonary bypass (CPB) in elderly patients.

METHODS

268 patients older than 65 years who underwent cardiac surgery with CPB at our institution in 2020 were included in the retrospective, single center, cohort study. Preoperative chest CT scans were used to measure the cross-sectional areas of the ESM (ESM), which were then adjusted for body surface area (BSA) to determine the muscle mass index. Patients were categorized into sarcopenia and non-sarcopenia groups based on ESM/BSA scores, and their short- and long-term clinical outcomes were compared.

RESULTS

The ESM/BSA detected sarcopenia in 51.1% of patients. Patients with sarcopenia had significantly extended durations of stay in both the intensive care unit and the hospital compared to those without sarcopenia. Furthermore, the incidence of major adverse events was significantly higher in the sarcopenia group compared to the non-sarcopenia group (15.3% vs. 32.1%, P < 0.001). Furthermore, multivariate logistic regression analysis demonstrated that sarcopenia (OR 2.457, 95% CI 1.178-5.126, P = 0.017) independently predicted the risk of postoperative complications after adjusting for gender, preoperative nutritional status, serum albumin, estimated glomerular filtration rate, creatinine, white blood cell count, lymphocytes, type of surgery, surgical time, and aortic cross-clamp time. Kaplan-Meier survival analysis revealed a statistically significant difference in overall mortality between groups (log-rank P = 0.011). The Cox proportional hazards model identified preoperative sarcopenia as an independent risk factor for long-term mortality (HR, 2.132; 95% CI 1.144-3.972, P = 0.017).

CONCLUSION

Our study identified preoperative sarcopenia, assessed via ESM muscle mass on chest CT, as an independent predictor of postoperative complications and long-term overall mortality in elderly cardiac surgery patients with CPB.

摘要

背景

很少有研究在心脏手术前使用胸部计算机断层扫描（CT）评估由竖脊肌（ESM）确定的肌肉减少症。我们旨在探讨老年患者中通过ESM评估的肌肉减少症与体外循环（CPB）心脏手术后不良结局之间的关系。

方法

本回顾性单中心队列研究纳入了2020年在我院接受CPB心脏手术的268例65岁以上患者。术前胸部CT扫描用于测量ESM的横截面积，然后根据体表面积（BSA）进行调整以确定肌肉质量指数。根据ESM/BSA评分将患者分为肌肉减少症组和非肌肉减少症组，并比较他们的短期和长期临床结局。

结果

ESM/BSA检测出51.1%的患者存在肌肉减少症。与无肌肉减少症的患者相比，有肌肉减少症的患者在重症监护病房和医院的住院时间明显延长。此外，肌肉减少症组的主要不良事件发生率明显高于非肌肉减少症组（15.3%对32.1%，P<0.001）。此外，多因素逻辑回归分析表明，在调整了性别、术前营养状况、血清白蛋白、估计肾小球滤过率、肌酐、白细胞计数、淋巴细胞、手术类型、手术时间和主动脉阻断时间后，肌肉减少症（比值比2.457，95%置信区间1.178 - 5.126，P = 0.017）独立预测术后并发症的风险。Kaplan-Meier生存分析显示两组之间的总死亡率有统计学显著差异（对数秩P = 0.011）。Cox比例风险模型确定术前肌肉减少症是长期死亡率的独立危险因素（风险比，2.132；95%置信区间1.144 - 3.972，P = 0.017）。