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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 effect of coronary artery bypass graft (CABG) on the prognosis and cost of obese patients with Metabolic syndrome (MS). Methods This study included 863 patients who underwent simple CABG in Fu Wai Hospital of China from June 01, 2012 to September 30, 2012. Of the patients, 231 patients met the inclusion criteria and were divided into three groups: control (n = 84), MS normal weight (n = 117) and MS with obesity (n = 30). Major cardio-cerebrovascular adverse events and deaths and hospitalization costs were studied. Results There was no significant difference in postoperative hospitalized new-onset atrial fibrillation, renal failure, myocardial infarction, stroke incidence and mortality, and postoperative ICU stay time between the three groups (p> 0.05). Compared with the control group, there was no significant difference in postoperative hospital stay in MS normal weight group (p> 0.05). The postoperative hospital stay in MS with obesity group was prolonged (P <0.05). One-year postoperative mortality, stroke, myocardial infarction, heart block, cardiac arrest and one year cardiovascular and cerebrovascular adverse events (MACCE) were not significantly different among the three groups (p> 0.05). There was no significant difference in hospitalization costs between the three groups before surgery, intraoperative and postoperative (p> 0.05). However, compared with the control group, there was no significant difference in the total cost of hospitalization for MS normal weight group (p> 0.05). The total cost of hospitalization for MS with obesity group increased statistically (p <0.05). Conclusion The normal weight of MS has no effect on the prognosis of CABG patients. MS with obesity had no effect on the incidence of postoperative hospitalizations and one year cardiovascular and cerebrovascular adverse events in CABG and mortality. However, MS with obesity has a significant effect on prolonging the postoperative hospital stay and increasing the total cost of hospitalization for CABG patients.