肥胖对急性A型主动脉夹层术后并发症的影响  

The effect of obesity on perioperative complications in patients with acute Stanford A aortic dissection

作　　者：张洁[1] 郑智[1] 潘友民[1] ZHANG Jie;ZHENG Zhi;PAN Youmin(Department of Cardiothoracic and Vascular Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院心脏大血管外科,武汉430030

出　　处：《临床外科杂志》2023年第4期344-347,共4页Journal of Clinical Surgery

摘　　要：目的分析肥胖对急性A型主动脉夹层术后并发症的影响。方法2021年9月~2022年2月行手术治疗的A型主动脉夹层病人133例,依据体重指数(BMI)分为两组,肥胖组(BMI≥28kg/m^(2))55例,非肥胖组(BMI<28kg/m^(2))78例。比较两组病人术后低氧血症、呼吸机辅助时间、肺部感染、神经系统并发症、急性肾损伤、伤口愈合不良、输血量、院内死亡率、住院时间等的差异。结果肥胖组术后低氧血症、拔管时间≥96小时、伤口愈合不良、心外重症监护病房(CSICU)住院时间≥7天、总住院时间≥20天比例高于非肥胖组,差异有统计学意义(P<0.05),两组术后急性肾损伤、肺部感染、神经系统并发症、院内死亡率比较无明显差异(P>0.05)。BMI≥28kg/m^(2)、拔管时间≥96小时、肺部感染是A型主动脉夹层术后CSICU住院时间≥7天的主要独立危险因素。其中,BMI≥28kg/m^(2)病人术后CSICU住院时间≥7天是非肥胖病人的2.45倍。结论肥胖增加A型主动脉夹层术后并发症的发生,且是CSICU住院时间≥7天的独立危险因素,但院内死亡率无明显差异。Objective To investigate the effect of obesity on perioperative complications in patients with acute Stanford A aortic dissection(TAAD).Methods According to BMI,the patients were divided into obese group(BMI≥28kg/m^(2))and non-obese group(BMI<28kg/m^(2)).The obese group included 55 cases,the non-obese group included 78 cases,133 cases in total.The differences of postoperative hypoxemia,ventilator assistance time,pulmonary infection,nervous system complications,acute kidney injury,poor wound healing,blood transfusion volume,hospital mortality and length of stay were compared between the two groups.Results The proportion of hypoxemia,extubation time≥96 hours,poor wound healing,CSICU(Cardiac Surgery Intensive Care Unit)≥7 days and total hospital stay≥20 days in obese group were significantly higher than those in non-obese group(P<0.05),there was no significant difference in postoperative acute renal injury,pulmonary infection,neurological complications and in-hospital mortality between the two groups(P>0.05).BMI≥28km^(2),extubation time≥96h,and pulmonary infection were the main independent risk factors for hospital stay≥7 days in CSICU after Type A aortic dissection.Patients with BMI≥28kg/m^(2)had 2.45 times more CSICU hospital days(≥7 days)than non-obese patients.Conclusion Obesity increases the incidence of perioperative complications in patients with acute Stanford A aortic dissection and is an independent risk factor for hospital stay of≥7 days in CSICU,but there is no significant difference in in-hospital mortality.

关 键 词：肥胖 A型主动脉夹层 围术期并发症 

分 类 号：R654.3[医药卫生—外科学]