代谢综合征伴肥胖患者对冠状动脉旁路移植术预后和费用的影响

Effects of Metabolic Syndrome with obesity on outcomes and costs after Coronary Artery Bypass Graft

目的评价代谢综合征(Metabolic syndrome,MS)肥胖患者对冠状动脉旁路移植术(coronary artery bypass graft,CABG)预后和费用的影响。方法本研究包括中国阜外医院于2012年6月01日-2012年9月30日接受单纯CABG的863名患者。在所有的患者中,231名患者达到入选标准并被分为3组:对照组(n=84),MS正常体重组(n=117)和MS伴肥胖组(n=30)。患者主要的心脑血管不良事件和死亡以及住院费用被研究。结果三组患者间术后住院新发房颤、肾功能衰竭、心肌梗死、脑卒中发生率和死亡率以及术后ICU停留时间差异无统计学意义(p>0.05)。与对照组比较,MS正常体重组术后住院时间差异无统计学意义(p>0.05),MS伴肥胖组术后住院时间延长,有统计学意义(P<0.05)。三组患者间术后一年死亡率、脑卒中、心肌梗死、心脏传导阻滞、心脏停搏和一年心脑血管不良事件(MACCE)发生率差异无统计学意义(p>0.05)。三组患者间术前、术中、术后住院费用差异无统计学意义(p>0.05)。然而,与对照组比较,MS正常体重组住院总费用差异无统计学意义(p>0.05),MS伴肥胖组住院总费用增加,有统计学意义(p<0.05)。结论 MS体重正常对CABG患者的预后没有影响。MS伴肥胖对CABG患者术后住院和一年心脑血管不良事件的发生率和死亡率没有影响。然而,MS伴肥胖对延长CABG患者术后住院时间和增加其住院总花费有着显著影响。

Objective To evaluate the effects of metabolic syndrome（MS） with obesity on outcomes and costs after coronary artery bypass graft（CABG）. Methods An obser vational cohor t study was perfor med on 863 consecutive patients receiving isolated primar y CABG in Fuwai hospital during June.1st, 2012 to December. 31 st, 2012. Of all patients, 231 patients met the inclusion criteria and were divided into three groups： control, MS with normal weight and MS without obesity（n = 84, 117 and 30 respectively）. The patient＇s major adverse cerebral and cardiovascular events and death and costs were studied. Results Among all three groups, there were no significant differences in in-hospital postoperative complications including atrial fibrillation, renal failure, myocardial infarction, stroke,death and ICU stay time（p〈0.05）.Compared with group control, the patients in MS with obesity group were associated with significant increased post-operative hospital stay（p〉0.05）, and no significant change was found in MS with normal weight group（p〉0.05）.There were also no significant differences in one year post-operative death, stroke, myocardial infarction, heart block, cardiac arrest and one year adverse cerebral and cardiovascular events（MACCE） among all three groups（p〉0.05）.There were no significant differences in pre-, pere- and postoperative costs among all three groups（p〉0.05）. Compared with group control, the patients in MS with obesity group were associated with significant increased in-hospital total costs（p〉0.05）,and no significant change was found in MS with normal weight group（p〉0.05）. Conclusions Patients with metabolic syndrome and obesity are associated with significant increased post-operative hospital stay and inhospital total costs, while metabolic syndrome with normal weight do not worsen outcomes after CABG.