Cozanitis D A
Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland.
Anaesthesiol Reanim. 2004;29(1):16-8.
It is generally believed that in hypertensive patients both beta adrenoreceptor antagonists and calcium channel blockers can be continued up to the day of surgery without provoking problems with cardiovascular stability intra- and postoperatively. The same, however, has not been definitively established for angiotension converting enzyme inhibitors (ACEIs). A patient who was taking the ACAI enalapril for hypertension underwent two similar operations--right total hip replacement and three years later left--both with spinal anaesthesia. In the initial case, she received her enalapril on the morning of surgery, while for the second procedure, enalapril was stopped 48 hours earlier. Hypotension occurred which required more than 5 times the dose of etilefrin to maintain suitable blood pressure during the first instance as compared to that when enalapril had been discontinued 48 hours earlier. Spinal anaesthesia in conjunction with an ACEI may result in severe hypotension as seen in this patient. In view of this, it is suggested that in contrast to other antihypertenisve drugs, ACEIs should be withdrawn well in advance of spinal anaesthesia.
一般认为，高血压患者在手术当天前均可继续使用β肾上腺素能受体拮抗剂和钙通道阻滞剂，而不会引发术中和术后心血管稳定性问题。然而，血管紧张素转换酶抑制剂（ACEIs）的情况尚未明确。一名服用ACAI依那普利治疗高血压的患者接受了两次类似手术——右全髋关节置换术，三年后进行左全髋关节置换术——均采用脊髓麻醉。在第一例手术中，她在手术当天早上服用了依那普利，而在第二次手术中，依那普利提前48小时停用。与依那普利提前48小时停药相比，第一次手术时发生了低血压，维持合适血压所需的去氧肾上腺素剂量是前者的5倍多。脊髓麻醉联合ACEI可能导致严重低血压，如该患者所见。鉴于此，建议与其他抗高血压药物不同，ACEIs应在脊髓麻醉前提前停用。
