体质量指数对不停跳冠状动脉旁路移植术的早期影响

The effect of body mass index on early postoperative clinical outcomes following off-pump coronary artery bypass grafting

目的 探讨体质量指数对不停跳冠状动脉旁路移植术（OPCABG）后早期的影响.方法 2015年1月到2015年5月,连续记录在北京安贞医院完成的1062例OPCABG患者,根据体质量指数（BMI）分为体质量正常组（360例）,超重组（527例）和肥胖组（175例）,比较3组间手术死亡比例,房颤发生比例、主动脉内球囊反搏（IABP）使用比例,多器官衰竭评分系统（MODS）、心脏外科术后评分系统（PSCS）和序贯衰竭评分系统（SOFA）以及呼吸指数（PaO2/FiO2）,心率×中心静脉压/平均动脉压（pres-sure-adjusted heart rate,PAHR）.结果 超重组的手术死亡比例最低,为0.6％,显著低于体质量正常组（2.2％）和肥胖组（1.1％）,P〈0.01.肥胖组的房颤发生比例最低,为20.1％,显著低于体质量正常组（22.1％）和超重组（20.7％）,P〈0.01.IABP使用比例,体质量正常组最高,为8.1％,其次为超重组（6.0％）和肥胖组（2.9％）,P〈0.01.在手术当日和手术后第1天,肥胖组的MODS,SOFA和PSCS评分显著高于体质量正常组,P〈0.01.肥胖组的PaO2/FiO2显著低于体质量正常组,P〈0.01.肥胖组的PAHR显著高于体质量正常组,P〈0.01.结论 随着BMI的增加,肥胖组OPCABG术后死亡比例、房颤发生比例和IABP使用比例低于BMI正常组,其中超重组的死亡比例最低.

Objective To investigate the effect of body mass index on early postoperative clinical outcomes following off-pump coronary artery bypass grafting. Methods A total of 1062 patients that received OPCABG in Beijing Anzhen Hospital were recorded continuously from January 2015 to May 2015. The patients were divided into normal weight group（n=360）, overweight group（n=527） and obesity group（n=175） according to their body mass index. The following outcomes in the ear-ly postoperative period were compared among the three groups： hospital mortality, atrial fibrillation and intra aortic balloon counter pulsation usage, multiple organ failure score system, postoperative score for cardiac surgery, sequential organ failure assessment score, respiratory index, and pressure-adjusted heart rate. Results The lowest mortality rate was observed in the overweight group（0.6％） in comparison with the normal weight group（2.2％） and obesity group（1.1％）（P〈0.01）. The lowest rate of atrial fibrillation was observed in the obesity group（20. 1％） in comparison with the normal weight group （22.1％） and overweight group（20. 7％）（P 〈0. 01）. The IABP usage rate was the highest in the normal weight group （8. 1％）, followed by the overweight group（6. 0％） and the obesity group（2. 9％）（P〈0. 01）. On the operation day and the first day after operation, the MODS, SOFA and PSCS scores of the obese group were significantly higher than those of the nor-mal weight group（P 〈0. 01）. PaO2/FiO2 in the obese group was significantly lower than that in the normal weight group （P〈0. 01）. PAHR in the obese group was significantly higher than that in the normal weight group（P〈0. 01）. Conclusion High BMI groups were associated with lower rates of mortality, atrial fibrillation, and IABP utilization. The lowest mortality rate was observed in the overweight group.