颈动脉内膜剥脱术后体重指数与早期预后的关系

Relationship between body mass index and early outcomes after carotid endarterectomy

目的针对肥胖与颈动脉内膜剥脱术(CEA)不良结局相关性的现有结果不一致,本研究旨在探讨体重指数升高与颈动脉内膜剥脱术后30 d并发症的相关性。方法这项队列研究包括2012-2022年邯郸市第一医院和邢台市人民医院收治的398例CEA患者。其中体重指数正常者(18.5-24.9 kg/m^(2))138例,超重者(25.0-29.9 kg/m^(2))188例,肥胖者(≥30 kg/m^(2))72例。采用Logistic回归分析评估超重和肥胖与CEA早期结局的相关性。结果CEA围手术期(30 d)内所有患者术后发生心肌梗死1例(0.25%)、卒中和短暂性脑缺血发作(TIA)12例(3.0%),术后死亡2例(0.5%)。在其他并发症中,出血10例(2.5%),呼吸道术后并发症2例(0.5%),泌尿系并发症2例(0.5%),心脏并发症3例(0.75%),颅神经损伤4例(1.0%),13例(3.3%)患者需再次手术。围手术期(30 d)的结果在各组之间没有显著差异。与正常体重的患者相比,超重患者的出血频率显著减少(P<0.05)。结论超重和肥胖与死亡率增加、TIA、卒中、心肌梗死或轻微并发症以及CEA后再次手术无明显相关性。而出血却相反,与正常体重的患者相比,超重患者CEA后术区出血的发生率明显减少。

Objective To explore the relationship between increased body mass index(BMI)and complications 30 days after carotid endarterectomy.Methods In this cohort study 398 cases of CEA were conducted in Handan First Hospital and the People's Hospital of Xingtai City from 2012 to 2022,with 138 cases with normal body mass index(18.5-24.9 kg/m^(2)),188 cases with overweight index(25.0-29.9 kg/m^(2))and 72 cases with obesity index(≥30 kg/m^(2)).Logistic regression analysis was used to evaluate the correlation between overweight or obesity and the early outcomes of carotid endarterectomy.Results Within perioperative period of CEA(30 days),postoperative myocardial infarction was seen in 1 case(0.25%),postoperative stroke and transient ischemic attack(TIA)in 12 cases(3.0%)and postoperative death in 2 cases(0.5%).As for other complications,10 cases bled(2.5%),2 cases had problems in respiratory tract(0.5%),urinary,cardiac and cranial nerve injuries occurred in 2 cases(0.5%),3 cases(0.75%)and 4 cases(1.0%)respectively,and 13 cases(3.3%)needed reoperation.There was no significant difference in perioperative(30 days)results among these three groups,but the frequency of bleeding in overweight patients was significantly lower than that in patients with normal weight(P<0.05).Conclusion Both overweight and obesity indexes were not significantly associated with upregulated mortality,TIA,stroke,myocardial infarction,mild complications or reoperation after carotid endarterectomy,whereas the incidence rate of bleeding in operating area after CEA in overweight patients was significantly downregulated compared with that in patients with normal weight.