Oman Medical Specialty Board, Muscat, Oman.
Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman.
Clin Obes. 2021 Dec;11(6):e12483. doi: 10.1111/cob.12483. Epub 2021 Aug 19.
There have been increased reports of orthostatic intolerance post-bariatric surgery. However, the prevalence, pathophysiology and long-term outcomes have not been well described. Therefore, we sought to summarize evidence of orthostatic intolerance after bariatric surgery. We conducted a systematic review using PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (CENTRAL) to identify relevant articles from the date of inception until 1st April 2020. Study selection, data extraction and quality assessment of the included studies were performed independently by two reviewers. The findings of the included studies were narratively reported. When feasible, a meta-analysis was done to summarize the relevant results. We included 20 studies (n = 19 843 participants) reporting findings of 12 prospective cohort studies, 5 retrospective cohort studies, 2 cross-sectional studies and one randomized controlled trial. The 5-year cumulative incidence of orthostatic intolerance was 4.2% (one study). Common clinical presentations of orthostatic intolerance were lightheadedness, dizziness, syncope and palpitation. The pooled data suggested improvement in overall cardiac autonomic function (sympathetic and parasympathetic) post-bariatric surgery. In addition, a significant systolic blood pressure drop may reflect a reset of the balance between the sympathetic and parasympathetic nervous systems after weight loss in the pooled analysis. Existing literature on orthostatic intolerance post-bariatric surgeries was limited or of low quality, and larger studies are needed to know the true incidence of orthostatic intolerance post-bariatric surgeries and the pathophysiology. We found one study reporting the 5-years cumulative incidence of orthostatic intolerance post-bariatric surgeries as only 4.2%. This could challenge the idea of increased orthostatic intolerance prevalence post-bariatric surgeries. Registration The review protocol was registered at the International Prospective Register of Systemic Reviews PROSPERO (CRD42020170877).
术后直立不耐受的报告有所增加。然而，其流行程度、病理生理学和长期结果尚未得到很好的描述。因此，我们旨在总结减重手术后直立不耐受的证据。我们使用 PubMed、Scopus、CINAHL、Cochrane 系统评价数据库和 Cochrane 对照试验中心注册库（CENTRAL）进行了系统评价，以从成立日期到 2020 年 4 月 1 日期间确定相关文章。两名评审员独立进行了研究选择、纳入研究的数据提取和质量评估。纳入研究的结果以叙述性报告的形式呈现。在可行的情况下，进行了荟萃分析以总结相关结果。我们纳入了 20 项研究（n=19843 名参与者），这些研究报告了 12 项前瞻性队列研究、5 项回顾性队列研究、2 项横断面研究和 1 项随机对照试验的结果。直立不耐受的 5 年累积发生率为 4.2%（一项研究）。直立不耐受的常见临床表现为头晕、头晕、晕厥和心悸。汇总数据表明，减重手术后总体心脏自主功能（交感和副交感）得到改善。此外，在汇总分析中，血压显著下降可能反映了体重减轻后交感和副交感神经系统之间平衡的重置。关于减重手术后直立不耐受的现有文献有限或质量较低，需要更大规模的研究来了解减重手术后直立不耐受的真实发生率和病理生理学。我们发现一项研究报告称，减重手术后直立不耐受的 5 年累积发生率仅为 4.2%。这可能对减重手术后直立不耐受发生率增加的观点提出挑战。注册 该综述方案已在国际前瞻性系统评价注册库 PROSPERO（CRD42020170877）中注册。
