Salim Fahad, Khan Fazal, Nasir Muhammad, Ali Rashid, Iqbal Ayesha, Raza Amir
Anaesthesiology, Aga Khan University, Karachi, PAK.
Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK.
Cureus. 2020 Jan 9;12(1):e6614. doi: 10.7759/cureus.6614.
Introduction The renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors. Material and methods This descriptive case series study was conducted at a tertiary hospital in a developing country after approval from the Ethics Review Committee. A total of 115 adult patients, from 16 to 60 years of age, who have undergone elective surgery, have controlled hypertension on the desired drugs for at least six months, have no history of any cardiac event, and have taken the drug on the morning of the surgery, were included in the study after written consent. The demographic data of the patients were entered into the proforma. Preoperative systolic, diastolic, and mean arterial pressure were recorded by the researcher or an assignee in the preoperative holding area. The patients were followed in the recovery room by the team conducting the study until 10 minutes after the arrival of the patient in the recovery room. All statistical analyses were performed using Statistical Packages for the Social Sciences version 19 (SPSS Inc., Chicago, IL). p-value ≤0.05 was considered significant. Results Of the 115 patients, 56 (48.7%) patients were in the age group between 51 and 60 years of age; 38 patients were between the ages of 41 and 50 years and only 21 patients were 40 years or less. On gender, 68 patients were female and 47 were male. According to body mass index (BMI), the majority of the patients were in the overweight group, amounting to 53 (46%), and 86 (74.78%) patients were known diabetics. Overall, 77 (66.96%) of the patients developed intraoperative hypotension with 41 (35.65%) patients requiring the use of vasopressors in order to correct the hypotension. No statistically significant difference was found between demographic and clinical variables. Conclusion Intraoperative hypotension is more frequent in patients with controlled hypertension on ACE inhibitors although more studies need to be conducted on a larger population in order to determine a more definitive result.
引言 肾素-血管紧张素-醛固酮系统（RAAS）是高血压治疗的重要靶点。血管紧张素转换酶（ACE）抑制剂可阻断血管紧张素I向血管紧张素II的转化。ACE抑制剂不仅能治疗高血压，还能降低心力衰竭患者和急性心肌梗死患者的发病率和死亡率。术前停用ACE抑制剂仍存在争议。为评估我国人群中该问题的当前严重程度，我们旨在开展本研究，评估术前使用ACE抑制剂的高血压患者麻醉诱导后术中低血压的发生率。
材料与方法 本描述性病例系列研究在一家发展中国家的三级医院进行，经伦理审查委员会批准。共有115例年龄在16至60岁之间的成年患者纳入研究，这些患者接受了择期手术，使用所需药物控制高血压至少六个月，无任何心脏事件史，且在手术当天早晨服用了该药物，所有患者均签署了书面知情同意书。患者的人口统计学数据录入表格。研究人员或其指定人员在术前等候区记录患者术前的收缩压、舒张压和平均动脉压。研究团队在恢复室对患者进行随访，直至患者到达恢复室后10分钟。所有统计分析均使用社会科学统计软件包第19版（SPSS Inc.，芝加哥，伊利诺伊州）进行。p值≤0.05被认为具有统计学意义。
结果 115例患者中，56例（48.7%）年龄在51至60岁之间；38例年龄在41至50岁之间，仅21例年龄在40岁及以下。性别方面，68例为女性，47例为男性。根据体重指数（BMI），大多数患者属于超重组，占53例（46%），86例（74.78%）患者为已知糖尿病患者。总体而言，77例（66.96%）患者发生术中低血压，41例（35.65%）患者需要使用血管升压药来纠正低血压。在人口统计学和临床变量之间未发现统计学上的显著差异。
结论 术前使用ACE抑制剂控制高血压的患者术中低血压更为常见，尽管需要对更多人群进行更多研究以得出更确切的结果。
