Uticaj gojaznosti na rani mortalitet nakon koronarne bypass hirurgije

  • Nada Čemerlić-Adjić Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Katica Pavlović Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
  • Marija Jevtić Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Institute of Public Health of Vojvodina, Novi Sad, Serbia
  • Radmila Velicki Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Institute of Public Health of Vojvodina, Novi Sad, Serbia
  • Saša Kostovski Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia
  • Lazar Velicki Institute of Cardiovascular Diseases of Vojvodina, Sremska Kamenica, Serbia; Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
DOI: https://doi.org/10.2298/1653
Ključne reči: obesity||, ||gojaznost, body mass index||, ||telesna masa, indeks, myocardial revascularization||, ||miokard, revaskularizacija, postoperative period||, ||postoperativni period, mortality||, ||mortalitet,

Sažetak


Uvod/Cilj. U ranijim radovima nagovešteno je da povišen indeks telesne mase (ITM) može biti koristan i da se može smatrati preventivnim faktorom kada se radi o ishodu operacije kod bolesnika koji se podvrgavaju koronarnoj bypass hirurgiji. Istovremeno, gojaznost se dovodi u vezu sa nastankom i razvojem koronarne bolesti. Cilj ove studije bio je utvrđivanje značaja paradoksa gojaznosti kod bolesnika koji su upućeni na hiruršku revaskularizaciju miokarda, kao i isptivanje uticaja gojaznosti na rani ishod koronarne hirurgije. Metode. Studijom je obuhvaćen 791 bolesnik podvrgnut izolovanoj koronarnoj hirurgiji tokom jednogodišnjeg perioda (2010. godina). Prosečno životno doba 568 (71,8%) bolesnika muškog pola i 223 (28,2%) bolesnika ženskog pola iznosilo je 62,33 ± 8,12 godina, dok je prosečna vrednost logističkog EuroSCORE iznosla 3,42%. Bolesnici su bili svrstani u tri grupe shodno njihovom ITM: I – ITM < 24,9 kg/m2; II – ITM 25-30 kg/m2; III – ITM > 30 kg/m2. Regresiona analiza korišćena je kako bi se ispitalo da li je ITM nezavisni prediktor ranog mortaliteta nakon koronarne hirurgije. Rezultati. Većina bolesnika imala je prekomernu telesnu masu (49%) ili su bili gojazni (30%). Nije postojala povezanost između ITM i pola (p = 0,398). Prosečna rana smrtnost iznosila je 2,15% (1,85% u grupi I, 2,06% u grupi II i 2,51% u grupi III; p = 0,869). Univarijantna analiza pokazala je da se gojaznost ne može smatrati nezavisnim faktorom rizika od ranog mortaliteta nakon koronarne hirurgije (unakrsni odnos 1,021; 95% interval poverenja 0,910–1,145; p = 0,724). Dužina postoperativnog bolničkog perioda bila je uporediva među ITM grupama (p = 0,502). Zaključak. U poređenju sa negojaznim bolesnicima, bolesnici sa prekomernom telesnom masom i gojazni imaju sličnu stopu ranog mortaliteta nakon koronarne hirurgije. Ova studija može potvrditi prisustvo paradoksa gojaznosti samo u smislu da bolesnici sa povišenim ITM imaju uporediv ishod operacije sa negojaznim bolesnicima. Dalja istraživanja su neophodna kako bi se odredili mehanizmi koji utiču na to da gojaznost postane protektivni faktor za koronarnu hirurgiju.

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Objavljeno
2015/04/21
Broj časopisa
Vol. 71 Br. 1 (2014)
Rubrika
Originalni članak