体质量指数对机器人心脏外科术临床结局的影响  

Effect of body mass index on clinical outcomes after robotic cardiac surgery

作　　者：吴文军 丁任重 陈建明 袁烨 宋毅 谢玲 严曼榕 胡义杰 WU Wenjun;DING Renzhong;CHEN Jianming;YUAN Ye;SONG Yi;XIE Ling;YAN Manrong;HU Yijie(Department of Cardiovascular Surgery,Daping Hospital of Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院心脏血管外科,4000422

出　　处：《心肺血管病杂志》2023年第9期922-928,共7页Journal of Cardiovascular and Pulmonary Diseases

基　　金：重庆市科卫联合医学科研项目(2018ZDXM003)。

摘　　要：目的:探讨BMI对机器人心脏外科术后临床结局的影响,并探讨术后肥胖悖论。方法:回顾性分析陆军军医大学大坪医院2016年7月至2022年6月间146例机器人体外循环(cardiopulmonary bypass,CPB)下心脏外科手术患者的资料,统计其人口学资料及相关的临床资料。平均年龄(42.9±13.0)岁,男性55例(37.7%)、女性91例(62.3%)。按患者术前BMI水平分三组:偏瘦组(BMI<18.5kg/m2,n=17,11.6%)、正常组(18.5≤BMI<23.9kg/m2,n=81,55.5%)、超重及肥胖组(BMI≥24kg/m2,n=48,32.9%)。多变量分析比较不同BMI组的临床结局。结果:不同BMI组术前资料显示:年龄、身高、体质量、BMI、体表面积(body surface area,BSA)、糖尿病、LAD、TG、HDL、淋巴细胞数(lymphocyte count,LY)存在统计学差异(P均<0.05)。术后临床结局显示超重及肥胖组术后发生心脏手术相关急性肾功能损伤(cardiac surgery-related acute kidney injury,CSA-AKI)风险明显升高(P=0.02),进一步多因素二元Logistic回归分析提示术前TG(OR=1.772,95%CI:1.068~2.942,P=0.03)、手术时间≥300min(OR=3.823,95%CI:1.098~13.308,P=0.03)是术后CSA-AKI的危险因素。结论:超重及肥胖心脏术后易发生CSA-AKI,不支持肥胖悖论;术前TG、手术时间≥300min是术后CSA-AKI的危险因素。Objective:To investigate the effect of BMI on clinical outcomes after robotic cardiac surgery,and to explore the postoperative obesity paradox.Methods:The data of 146 patients who underwent cardiac surgery under robotic 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(42.9±13.0)years,55(37.7%)were male and 91(62.3%)were female.Patients were divided into three groups according to preoperative BMI levels:lean group(BMI<18.5kg/m2;n=17;11.6%),normal group(18.5≤BMI<23.9kg/m2;n=81;55.5%),and overweight and obese group(BMI≥24kg/m2;n=48;32.9%).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,BMI,body surface area(BSA),diabetes,LAD,TG,HDL,and lymphocyte count(LY)(P<0.05 for all).Postoperative clinical outcomes showed that the risk of cardiac surgery-related acute kidney injury(CSA-AKI)was significantly increased in the overweight and obese groups(P=0.02),and further multivariate binary Logistic regression analysis suggested that preoperative TG(OR=1.772,95%CI:1.068~2.942,P=0.03),operation time≥300 min(OR=3.823,95%CI:1.098~13.308,P=0.03)were risk factors for postoperative CSA-AKI.Conclusions:Overweight and obese patients are prone to develop CSA-AKI after cardiac surgery,which does not support the obesity paradox;preoperative TG and operation time≥300 min are independent risk factors for postoperative CSA-AKI.

关 键 词：机器人手术 心脏手术 体外循环 体质量指数 急性肾功能损伤 

分 类 号：R54[医药卫生—心血管疾病]