肥胖和选择性胸腔腹腔大动脉动脉瘤修复后的结果
Sanford Zeigler1, Kyle W Blackburn2, Ahmad Tabatabaeishoorijeh3
1Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC.
JTCVS open
|May 1, 2025
概括
肥胖不会增加开放胸腔腹腔大动脉瘤 (TAAA) 修复的手术风险. 在肥胖和非肥胖患者之间,调整后的结局和生存率相似,支持所有符合条件的个体的TAAA修复.
科学领域:
- 血管外科 血管外科
- 心血管外科心血管外科
- 手术结果研究研究.
背景情况:
- 肥胖是心血管健康日益关注的问题,可能会使手术过程复杂化.
- 肥胖对开放胸腔腹腔大动脉瘤 (TAAA) 修复后的结果的影响尚未得到充分证实.
- 了解这些关系对于手术决策和患者管理至关重要.
研究的目的:
- 研究在接受选择性开放TAAA修复的患者中肥胖和手术风险之间的关联.
- 为了比较TAAA修复后肥胖和非肥胖患者的早期和晚期结果,包括存活率.
- 确定接受TAAA修复的肥胖患者手术后死亡率的预测因素.
主要方法:
- 追溯分析了1986年至2023年期间进行的2517次公开的,可选的TAAA维修.
- 肥胖患者 (体重指数 (BMI) ≥30) 与没有肥胖患者 (BMI 18.6-29.9) 的比较.
- 对死亡率预测因子的多变量逻辑回归和对结果的倾向匹配队列分析,包括通过卡普兰-梅尔分析的生存率.
主要成果:
- 肥胖患者比较年轻,患上大动脉剖析和糖尿病的比例更高. 操作死亡率相似 (5.6%对6.6%).
- 持久性中风在肥胖患者中更频繁 (3.7%对2.0%).
- 体重指数与手术死亡率无关;大动脉剖析独立预测肥胖患者的死亡率. 倾向匹配没有显示出显著的结果差异.
结论:
- 在选择性开放TAAA修复后,肥胖与增加的手术死亡率没有独立的关联.
- 尽管人口统计学和并发症差异,调整后的早期结果和晚期存活率在肥胖和非肥胖患者之间是可比的.
- 肥胖不应该成为提供选择性TAAA修复的禁忌.
相关概念视频
Pharmacokinetics in Obese Patients: Drug Absorption and Distribution
Obesity significantly alters the pharmacokinetic processes of drug absorption and distribution, presenting unique challenges in medical treatment. The increased fat tissue and decreased lean muscle in obese individuals can significantly affect how drugs are absorbed into the body and distributed across different tissues. This alteration can lead to variances in the effectiveness and safety of medications, necessitating adjustments in dosing or drug selection for obese patients.One notable...
Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...


