胸腔镜下左心耳夹持术后血清钠和血压的显著降低

Yiming Chen, Xuesong Han, C. Ye, Dong Xu
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摘要

背景:心外膜左心耳(LAA)关闭可能会导致由于LAA与循环分离而产生多余的利钠肽。因此,本研究旨在探讨手术后血压和电解质的可能变化。方法:这是一项回顾性观察性研究,包括52例有血栓性卒中史的房颤(AF)患者,他们接受了胸腔镜下的LAA夹夹。术前、释放装置后立即、术后第1天、第2天及出院时测定电解质、血压和脑利钠肽。结果:35例(66.04%)患者术后48 h血清钠水平下降大于4 mmol/L。出院时收缩压显著低于基线水平(118.99±12.29 mmHg vs. 122.93±13.82 mmHg, p = 0.034),舒张压与基线水平无显著差异(78.00±7.39 mmHg vs. 77.22±7.72 mmHg, p = 0.502)。术后观察到脑利钠肽显著增加,尽管出院时呈下降趋势。结论:心外膜LAA夹持术可引起术后血清钠的急性下降,提示术者术后应采取适当的进液量和血清钠水平管理。收缩压的降低表明患者从LAA剪切术中获益的可能性扩大,尽管需要进一步的研究来确定这种现象是否在长期随访中持续存在。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The Significant Decrease of Serum Sodium and Blood Pressure following Thoracoscopic Left Atrial Appendage Clipping
Background: The epicardial left atrial appendage (LAA) closure may induce unwanted natriuretic peptides caused by the isolation of the LAA from circulation. Thus, this study aims to explore the possible change of blood pressure and electrolytes following the procedure. Methods: This was a retrospective, observational study including 52 atrial fibrillation (AF) patients with a history of thrombolic stroke who underwent thoracoscopic LAA clipping. Electrolytes, blood pressure, and brain natriuretic peptide were measured before the procedure, immediately after the device release, on the 1st day, the 2nd day postoperation, and discharge. Results: Thirty-five (66.04%) patients’ serum sodium level decreased by more than 4 mmol/L during 48 h postoperation. The systolic blood pressure at discharge was significantly lower than the baseline level (118.99 ± 12.29 mmHg vs. 122.93 ± 13.82 mmHg, p = 0.034), while the diastolic blood pressure was not significantly different to the baseline (78.00 ± 7.39 mmHg vs. 77.22 ± 7.72 mmHg, p = 0.502). A significant increase in brain natriuretic peptide was observed postoperatively, although it showed a trend of decline at discharge. Conclusion: Epicardial LAA clipping could induce an acute decrease in serum sodium postoperation, which indicates to the surgeons that the postoperative intake fluid amounts and serum sodium level management should be more appropriate. The decrease in systolic blood pressure indicates the possibility of expanding the benefits that patients received from LAA clipping, though further studies are needed to determine if this phenomenon is persistent in the long-term follow-up.
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