肾素-血管紧张素系统抑制剂对肺动脉高压患者术后谵妄的影响：一项回顾性队列研究的二次分析

Influence of Renin-Angiotensin System Inhibitors on Postoperative Delirium in Patients With Pulmonary Arterial Hypertension: A Secondary Analysis of a Retrospective Cohort Study.

作者信息

Chen Gong, Zhou Sai, Deng Fang

机构信息

Department of Anesthesiology, The Third Xiangya Hospital of Central South University, Changsha, China.

Academic Affairs Department, Changsha Medical University, Changsha, China.

出版信息

Front Psychiatry. 2022 Apr 8;13:851104. doi: 10.3389/fpsyt.2022.851104. eCollection 2022.

DOI:10.3389/fpsyt.2022.851104

PMID:35463531

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9024170/

Abstract

OBJECTIVE

To investigate the correlation between preoperative use of ACEIs/ARBs and postoperative delirium (POD) in surgical patients with pulmonary arterial hypertension (PAH).

METHODS

The present study is a secondary analysis of a retrospective cohort study conducted at the University of Washington Medical Center from April 2007 to September 2013. Patients with PAH who underwent non-cardiac, non-obstetric surgery were enrolled in the original research. We further excluded stroke, sepsis, and craniotomy patients from interfering with POD evaluation. The univariate regression analysis and multivariate-adjusted model were used to explore the influence of preoperative ACEIs/ARBs use on the occurrence of POD.

RESULTS

A total of 539 patients were included in this study. The incidence of POD in these patients was 3.0%. Following the adjustment of potential confounders (age, BMI, smoking status, pulmonary arterial systolic pressure, length of surgery, vascular surgery, asthma, obstructive sleep apnea, renal failure, atrial fibrillation, coronary artery disease, hydrochlorothiazide, alpha-blocker, calcium channel blocker, antiplatelet, steroids, statin, isoflurane), a negative relationship was found between preoperative use of ACEIs/ARBs and occurrence of POD (OR = 0.15, 95%CI: 0.03 to 0.80, = 0.0266).

CONCLUSION

Preoperative use of ACEIs/ARBs in patients with PAH reduces the risk of POD. ACEIs/ARBs may be more recommended for patients with PAH in the future.

摘要

目的

探讨肺动脉高压（PAH）手术患者术前使用血管紧张素转换酶抑制剂（ACEIs）/血管紧张素Ⅱ受体阻滞剂（ARBs）与术后谵妄（POD）之间的相关性。

方法

本研究是对2007年4月至2013年9月在华盛顿大学医学中心进行的一项回顾性队列研究的二次分析。纳入了接受非心脏、非产科手术的PAH患者进行原始研究。我们进一步排除了中风、脓毒症和开颅手术患者对POD评估的干扰。采用单因素回归分析和多变量调整模型探讨术前使用ACEIs/ARBs对POD发生的影响。

结果

本研究共纳入539例患者。这些患者中POD的发生率为3.0%。在对潜在混杂因素（年龄、体重指数、吸烟状况、肺动脉收缩压、手术时长、血管手术、哮喘、阻塞性睡眠呼吸暂停、肾衰竭、心房颤动、冠状动脉疾病、氢氯噻嗪、α受体阻滞剂、钙通道阻滞剂、抗血小板药物、类固醇、他汀类药物、异氟烷）进行调整后，发现术前使用ACEIs/ARBs与POD的发生之间存在负相关（OR = 0.15，95%CI：0.03至0.80，P = 0.0266）。