Calloway James J, Memtsoudis Stavros G, Krauser Daniel G, Ma Yan, Russell Linda A, Goodman Susan M
Department of Internal Medicine, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA.
Department of Anesthesia, Hospital for Special Surgery and Weill Cornell Medical College, New York, NY, USA; Department of Public Health, Weill Cornell Medical College, New York, NY, USA.
J Am Soc Hypertens. 2014 Sep;8(9):644-51. doi: 10.1016/j.jash.2014.05.017. Epub 2014 Jun 12.
The aim was to investigate the association between continuing angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARB) with postinduction hypotension and vasoactive drug use in elderly orthopedic surgery patients under regional anesthesia. Retrospective design consisted of 114 patients (mean age 66) undergoing elective total knee arthroplasty, including 84 patients with chronic hypertension, and they were divided as group I (n = 37), ACEI/ARB continued; group II (n = 23), ACEI/ARB withdrawn; group III (n = 24), β-blocker/calcium channel blocker continued; and group IV (n = 30), without hypertension (control). Primary end points are systolic blood pressures (SBPs) and mean arterial blood pressures (MAPs) at 0, 30, 60, and 90 minutes postinduction, incidence of hypotension (SBP <85 mm Hg), and ephedrine requirements. Repeated measurements were analyzed using generalized estimating equations controlling for baseline characteristics and accounting for correlations. Logistic regression was used for remaining variables. Hypotension occurred more frequently (P = .02) in group I (30%) versus groups II-IV (9%, 13%, 3%). Ephedrine use was increased (P < .001) in group I (51%) compared with groups II-IV (26%, 17%, 7%). Group I had lower mean SBPs compared with group II (110 vs. 120; P = .0045) and group IV (110 vs. 119; P = .0013). Lower mean MAPs were found in group I versus group II (74 vs. 81, P = .001) and group IV (74 vs. 80; P = .001). Group I had an increased odds of receiving ephedrine versus group IV (odds ratio, 16.27; 95% confidence interval, 3.10-85.41; P = .001). No adverse clinical events were recorded. Day of surgery ACEI/ARB use is associated with a high incidence and severity of postinduction hypotension with associated high vasopressor requirements. Associated clinical outcomes merit further study.
目的是研究在区域麻醉下老年骨科手术患者中，继续使用血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）与诱导后低血压及血管活性药物使用之间的关联。回顾性研究设计纳入了114例行择期全膝关节置换术的患者（平均年龄66岁），其中84例患有慢性高血压，这些患者被分为四组：第一组（n = 37），继续使用ACEI/ARB；第二组（n = 23），停用ACEI/ARB；第三组（n = 24），继续使用β受体阻滞剂/钙通道阻滞剂；第四组（n = 30），无高血压（对照组）。主要终点指标为诱导后0、30、60和90分钟时的收缩压（SBP）、平均动脉压（MAP）、低血压发生率（SBP <85 mmHg）以及麻黄碱需求量。使用广义估计方程对重复测量数据进行分析，控制基线特征并考虑相关性。对其余变量采用逻辑回归分析。第一组低血压发生率（30%）高于第二至四组（分别为9%、13%、3%，P = 0.02）。与第二至四组（分别为26%、17%、7%）相比，第一组麻黄碱使用率增加（P < 0.001）。与第二组（110 vs. 120；P = 0.0045）和第四组（110 vs. 119；P = 0.0013）相比，第一组平均SBP较低。与第二组（74 vs. 81，P = 0.001）和第四组（74 vs. 80；P = 0.001）相比，第一组平均MAP较低。与第四组相比，第一组使用麻黄碱的几率增加（比值比，16.27；95%置信区间，3.10 - 85.41；P = 0.001）。未记录到不良临床事件。手术当日使用ACEI/ARB与诱导后低血压的高发生率和严重程度以及较高的血管升压药需求量相关。相关临床结局值得进一步研究。
