【罂粟摘要】肾素-血管紧张素-醛固酮抑制剂和其他抗高血压药物对麻醉前血压管理的临床影响

THE SPRING EQUINOX 肾素-血管紧张素-醛固酮抑制剂和其他抗高血压药物对麻醉前血压管理的临床影响     

贵州医科大学    麻醉与心脏电生理课题组

翻译：安丽  编辑：潘志军  审校：曹莹

背景:血压波动在高血压控制不佳的患者中更为显著，并且已知与围手术期不良并发症的发病率相关。在本研究中，我们旨在确定抗高血压药物治疗策略对麻醉前手术室血压的影响。

方法:招募了717名患者参加了我们的研究; 其中383名根据基线测量血压正常且未接受抗高血压治疗的患者被排除在分析之外。其余334例患者按抗高血压药物治疗分为6组。根据术前基线和麻醉前血压测量对这六组进行检查。 

结果: 研究结果发现，24%的患者因高血压而拒绝手术，使用肾素-血管紧张素-醛固酮系统抑制剂(RAASI)的患者麻醉前收缩压高于使用其他降压药的患者。与其他患者相比，接受β受体阻滞剂的患者麻醉前收缩压、舒张压和平均血压最低。

结论: 目前，RAASI是否应该在术前继续服用仍存在争议。我们的研究表明，RAASI不能提供最佳的麻醉前血压，并导致推迟手术的次数的增加，可能是由于术前停药所致。因此，应在未来的研究中重新评估 RAASI 术前停药方案。

原始文献来源：

Eda Balcı , Zeliha Aslı Demir , and Melike Bahçecitapar.Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure.Anesth Pain Med .2022;17:112-119.

Management of renin-angiotensin-aldosterone inhibitors and other antihypertensives and their clinical effects on pre-anesthesia blood pressure

Abstract

Background: Blood pressure fluctuations appear more significant in patients with poorly controlled hypertension and are known to be associated with adverse perioperative morbidi-ty. In the present study, we aimed to determine the effects of antihypertensive drug treat-ment strategies on preanesthetic operating room blood pressure measurements.

Methods: A total of 717 patients participated in our study; 383 patients who were normo-tensive based on baseline measurements and not under antihypertensive therapy were ex-cluded from the analysis. The remaining 334 patients were divided into six groups according to the antihypertensive drug treatment. These six groups were examined in terms of preop-erative baseline and pre-anesthesia blood pressure measurements.

Results: As a result of the study, it was observed that 24% of patients had high blood pres-sure precluding surgery, and patients using renin-angiotensin-aldosterone system inhibitors (RAASI) had higher pre-anesthesia systolic blood pressure than patients using other antihy-pertensive drugs. Patients who received beta-blockers were also observed to have the low-est pre-anesthesia systolic blood pressure, diastolic blood pressure, and mean blood pres-sure, compared to others.

Conclusions: Recently, whether RAASI should be continued preoperatively remains contro-versial. Our study shows that RAASI cannot provide optimal pre-anesthesia blood pressure and lead to an increase in the number of postponed surgeries, probably due to withdrawal of medication before the operation. Therefore, the preoperative discontinuation of RAASI should be reevaluated in future studies.

打赏