缺血性卒中病史的心房颤动患者左心耳夹闭术后血电解质与血压的改变分析  

Analysis of changes of electrolytes and blood pressure in atrial fibrillation patients with ischemic stroke history after left atrial appendage clipping surgery

作　　者：刘扬 徐东 LIU Yang;XU Dong(Department of Cardiovascular Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100000,China)

机构地区：[1]首都医科大学附属北京天坛医院心脏大血管外科,北京市100000

出　　处：《中国心血管病研究》2023年第6期555-559,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 研究通过E-Clip经胸腔镜进行左心耳夹闭手术后患者血压和电解质的改变。方法 回顾性纳入了52例自2019年9月至2022年6月于首都医科大学附属北京天坛医院心脏大血管中心成功行左心耳夹闭术的心房颤动(房颤)患者。于术前、术后当日、术后第1、2 d以及出院前测量收集患者血压、血钠、血钾以及脑钠尿肽(BNP)等数据,并对各项指标在术前术后各时间点的变化趋势进行分析。结果 共有35(66.04%)例患者的血钠水平于术后48 h内较术前下降超过4 mmol/L。出院时,患者平均舒张压与术前相比无明显改变,收缩压水平较术前明显下降[(118.99±12.29)mmHg比(122.93±13.82)mmHg,P<0.05]。患者BNP于术后即出现明显上升[236.15(140.90,304.80)pg/ml比203.10(90.50,294.90)pg/ml,P<0.05],出院时虽表现出下降趋势,但仍明显高于术前[227.90(106.10,343.30)pg/ml比203.10(90.50,294.90)pg/ml,P=0.035]。结论 有血栓性卒中病史的房颤患者在经胸腔镜行左心耳夹闭术后早期出现显著的血钠下降,提示临床医生应当在对患者进行术后液体管理以及利尿药使用时更加谨慎,避免由血钠骤降带来的术后并发症。Objective This study aims to explore the change in electrolytes and blood pressure following the video-assisted thoracoscopic left atrial appendage clipping surgery using E-clip system.Methods This was a retrospective,observational study including 52 stroke patients with AF who underwent thoracoscopic LAA clipping in the center of cardiac and vascular,Tiantan Hospital from September 2019 to June 2023..Electrolytes,blood pressure and brain natriuretic peptide were measured before the procedure,immediately after the device release,on 1st,2nd,3rd day postoperation,and discharge and the changing trend of the aforementioned index at each timepoint before and after surgery was analyzed.Results There were 35(66.04%)patients’serum sodium level decreased more than 4 mmol/L during 48 hours 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<0.05]while the diastolic blood pressure has no significant difference compared with baseline.A significant increase in brain natriuretic peptide was observed postoperatively[236.15(140.90,304.80)pg/ml vs.203.10(90.50,294.90)pg/ml,P<0.05],although it showed a trend of decline at discharge[227.90(106.10,343.30)pg/ml vs.203.10(90.50,294.90)pg/ml,P=0.035].Conclusion Epicardial LAA clipping 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 appropriate.

关 键 词：心房颤动 卒中 钠尿肽 收缩压 脑钠尿肽 

分 类 号：R514.7[医药卫生—内科学]