Læknablaðið - 15.04.2011, Blaðsíða 24

FRÆÐIGREINAR
RANNSÓKN
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25. Jarvinen O, Julkunen J, Tarkka MR. Impact of obesity on
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Impact of obesity on surgical outcomes following coronary artery bypass graft surgery
Introduction: Obesity has been related to increased
postoperative morbidity and mortality following open-heart
surgery. However, recent studies have shown no association
or even a more favourable outcome in obese patients. This
relationship was investigated in a well-defined cohort of patients
that underwent myocardial revascularisation in lceland.
Material and methods: A retrospective study including all
patients that underwent isolated myocardial revascularisation in
lceland from 2002 to 2006. Alltogether 720 patients were divided
into two groups, an obese group, with BMI >30 kg/m2 (n=207,
29%), and a non-obese group with BMI á30 kg/m2 (n=513,
71%). Patient demographics, complications, operative mortality
and long term survival of both groups were compared.
Results: Demographics were comparable between the groups.
Obese patients were 2.4 years younger, more likely to use
statins (83,3% vs. 71,2%, had a significantly lower EuroSCORE
(4.3 vs. 5.0) but a slightly longer operation time. Pleural fluid
was less often drained in obese patients (8.2 vs. 15.0%) but
rates for other complications were similar in both groups, as
was operative mortality s30 days (2.0% vs. 3.7%), 1 and 5
year survival. In a multivariate analysis obesity was not an
independent risk factor for minor or major complications,
operative mortality or long term survival.
Conclusion: The rate of complications and operative mortality
after myocardial revascularisation is not significantly higher
in obese patients and the same applies to long term survival.
This is true even after correcting for confounding factors in a
multivariate analysis.
Oddsson SJ, Sigurjonsson H, Helgadottir S, Sigurdsson Ml, Viktorsson SA, Arnorsson T, Gudbjartsson T.
Impact of obesity on surgical outcomes following coronary artery bypass graft surgery lcel Med J 2011; 97:223-8
Correspondence: Tómas Guðbjartsson, tomasgud@landspitali.is
Keywords: Coronary arterial revascularization, obesity, compiications, mortaiity, risk factors, survival.
Barst: 30. desember 2010, - samþykkt til birtingar: 23. febrúar 2011. Hagsmunatengsl: Engin
Ábendingar: Meðferð við beinþynningu eftir tíðahvörf hjá konum sem eru í
aukinni hættu á beinbrotum. Prolia dregur marktækt úr hættu á samfallsbrotum
í hryggjarliðum, öðrum beinbrotum og mjaðmarbrotum. Meðferð við beintapi í
tengslum við hormónabælingu hjá karlmönnum með blöðruhálskirtils krabbamein
sem eru í aukinni hættu á beinbrotum. Hjá karlmönnum með blöðruhálskirtils
krabbamein sem fá hormónabælandi meðferð dregur Prolia marktækt úr hættu á
samfallsbrotum í hryggjarlióum. Skammtar: 60 mg/ml S.C. 6. hvern mánuð. Engin
skammtaaðlögun við skerta nýrnastarfsemi. Skal ekki notað hjá sjúklingum < 18 ára.
Frábendingar: Blóðkalsíumlækkun, ofnæmi fyrir innihaldsefnunum. Varúðarreglur:
Allir sjúklingar skulu fá uppbótarmeðferð með kalsíum og D vítamíni. Sjúklinga sem
eiga blóðkalsíumlækkun frekar á hættu skal rannsaka nánar og leiðrétta ástandið
fyrir meðferð með Prolia. Sjúklingar sem fá einkenni húðsýkingar skulu leita læknis.
Beindrep í kjálka hefur mjög sjaldan komið fram, þó aðallega við notkun hærri skammta
en ráðlagðir eru (hjá krabbameinssjúklingum). Nálarhlíf inniheldur latexafleiðu, sem
getur valdið ofnæmisviðbrögðum. Sjúklingar með arfgengt frúktósaóþol eiga ekki að
fá Prolia. Milliverkanir: Engar upplýsingar. Meðganga og brjóstagjöf: Skal ekki nota
á meðgöngu. Hjá konum með barn á brjósti skal meta kosti og galla. Aukaverkanir:
Sýkingar, t.d. í þvagfærum og öndunarfærum. Settaugarbólga. Ský á augasteini.
Hægðatregða. Útbrot og exem. Verkir í útlimum. Blóðkalsíumlækkun (örsjaldan).
Samantekt á eiginleikum lyfs í heild fæst hjá GlaxoSmithKline ehf.
Pakkningar og verð nóvember 2010
ATC flokkur: M05BX04, Prolia 60 mg/ml, áfyllt sprauta verð kr. 52.194
Vörunúmer: 08 58 04. Afgreiðslutilhögun: R. Greiðsluþátttaka: 0.
Heimildir 1: Sérlyfjaskrá www.serlyfjaskra.is
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