Moady Gassan, Bickel Amitai, Shturman Alexander, Khader Muhammad, Atar Shaul
Department of Cardiology, Galilee Medical Center, Nahariya, Israel.
Department of Surgery, Galilee Medical Center, Nahariya, Israel.
Isr Med Assoc J. 2019 Oct;21(10):649-652.
Pneumatic sleeves (PS) are often used during laparoscopic surgery and for prevention of deep vein thrombosis in patients who cannot receive anticoagulation treatment. There is very little information on the hemodynamic changes induced by PS and their effect on brain natriuretic peptide (BNP) in patients with severely reduced left ventricular ejection function (LVEF).
To determine the safety and hemodynamic changes induced by PS and their effects on brain natriuretic peptide (BNP).
This study comprised 14 patients classified as New York Heart Association (NYHA) II-III with severely reduced LVEF (< 40%). We activated the PS using two inflation pressures (50 or 80 mmHg, 7 patients in each group) at two cycles per minute for one hour. We measured echocardiography, hemodynamic parameters, and BNP levels in each patient prior to, during, and after the PS operation.
The baseline LVEF did not change throughout the activation of PS (31 ± 10% vs. 33 ± 9%, P = 0.673). Following PS activation there was no significant difference in systolic or diastolic blood pressure, the pulse measurements, or central venous pressure. BNP levels did not change after PS activation (P = 0.074).
The use of PS, with either low or high inflation pressures, is safe and has no detrimental effects on hemodynamic parameters or BNP levels in patients with severely reduced LVEF following clinical stabilization and optimal medical therapy.
气袖（PS）常用于腹腔镜手术以及无法接受抗凝治疗的患者预防深静脉血栓形成。关于左心室射血功能（LVEF）严重降低的患者中PS引起的血流动力学变化及其对脑钠肽（BNP）的影响，相关信息非常少。
确定PS引起的安全性和血流动力学变化及其对脑钠肽（BNP）的影响。
本研究纳入了14例纽约心脏协会（NYHA）II-III级、LVEF严重降低（<40%）的患者。我们以两种充气压力（50或80 mmHg，每组7例患者）激活PS，每分钟两个周期，持续一小时。我们在PS操作前、操作期间和操作后测量每位患者的超声心动图、血流动力学参数和BNP水平。
在PS激活过程中，基线LVEF没有变化（31±10%对33±9%，P = 0.673）。PS激活后，收缩压或舒张压、脉搏测量值或中心静脉压没有显著差异。PS激活后BNP水平没有变化（P = 0.074）。
在临床稳定和最佳药物治疗后，对于LVEF严重降低的患者，使用低充气压力或高充气压力的PS是安全的，对血流动力学参数或BNP水平没有不利影响。
