Billakanty Sreedhar R, Kligman Mark D, Kanjwal Yousuf M, Kosinski Daniel J, Maly George T, Karabin Beverly, Grubb Blair P
Division of Cardiovascular Medicine, University of Toledo, Health Science Campus, Toledo, Ohio 43614, USA.
Pacing Clin Electrophysiol. 2008 Jul;31(7):884-8. doi: 10.1111/j.1540-8159.2008.01103.x.
As bariatric surgery has become an increasingly popular treatment for obesity, we have seen an increasing number of patients present after bariatric surgery with new-onset syncope, near-syncope, and lightheadedness.
We retrospectively reviewed patients who had had bariatric surgery referred to our institution for evaluation of orthostatic intolerance. We reviewed history, physical examination, type of bariatric surgery procedure, and tilt table test results in these patients. There were 14 women and one man with mean age 42 +/- 6 years, preoperative body mass index was 49.3 +/- 6.0 kg/m(2), and mean postoperative weight loss was 55.9 kg. Mean onset of symptoms was 5.2 +/- 3.9 months after surgery. Presenting symptoms were lightheadedness in 15 (100%), near-syncope in 11 (73%), and syncope in nine (60%). All but one patient had a positive tilt table test with eight (53%) having a neurocardiogenic response, three (20%) having a dysautonomic response, and (20%) having a postural tachycardia response. The likely mechanism of orthostatic intolerance is autonomic insufficiency in combination with reverse course of obesity-related hypertension. The majority of the patients (12 out of 15) responded to standard therapy for autonomic insufficiency.
Some patients may develop significant orthostatic intolerance due to autonomic insufficiency following bariatric surgery, and awareness of the potential association between bariatric surgery and new orthostatic intolerance is important for providing timely care.
随着减肥手术已成为越来越受欢迎的肥胖治疗方法，我们发现越来越多的减肥手术后患者出现新发晕厥、接近晕厥和头晕症状。
我们回顾性分析了因直立不耐受评估而转诊至我院接受减肥手术的患者。我们查阅了这些患者的病史、体格检查、减肥手术类型和倾斜试验结果。共有14名女性和1名男性，平均年龄42±6岁，术前体重指数为49.3±6.0kg/m²，术后平均体重减轻55.9kg。症状出现的平均时间为术后5.2±3.9个月。出现的症状包括头晕15例（100%）、接近晕厥11例（73%）和晕厥9例（60%）。除1例患者外，所有患者倾斜试验均为阳性，其中8例（53%）有神经心源性反应，3例（20%）有自主神经功能异常反应，4例（20%）有体位性心动过速反应。直立不耐受的可能机制是自主神经功能不全合并肥胖相关高血压的逆转。大多数患者（15例中的12例）对自主神经功能不全的标准治疗有反应。
一些患者在减肥手术后可能因自主神经功能不全而出现明显的直立不耐受，认识到减肥手术与新出现的直立不耐受之间的潜在关联对于及时提供治疗很重要。
