Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
Perfusion. 2023 Sep;38(6):1260-1267. doi: 10.1177/02676591221110425. Epub 2022 Jun 20.
The aim of this research is to determine the optimum blood pressure (BP) control goal for hypertensive type B aortic dissection (TBAD) patients undergoing surgery.
Between January 2019 and April 2021, 259 hypertensive TBAD patients undergoing surgery were included in the research. 98 patients received intensive BP control with a target of systolic BP (SBP) < 120 mmHg, and 161 received standard BP control targeting SBP between 120 and 140 mmHg. Clinical data from two groups were compared.
Patients who received intensive BP control experienced a significantly higher incidence of acute kidney injury (AKI) postoperatively (21/98, 21.4% vs 14/161, 8.7%, = 0.004). The intensive group took more anti-hypertensive drugs per day compared with the standard group (1.9 vs 1.5, < 0.001). Triple-drug combination treatment was more frequent in the intensive group (38.8% vs 14.3%, < 0.001), as were angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB; 67.3% vs 44.7%, 0.001), and thiazide-like diuretic (44.9% vs 18.0%, < 0.001).
Intensive BP control treatment increases the incidence of AKI and raises the utilization of the anti-hypertensive drug, but did not reduce the operative mortality and late mortality in TBAD patients undergoing surgical repair.
本研究旨在确定接受手术治疗的高血压 B 型主动脉夹层（TBAD）患者的最佳血压（BP）控制目标。
2019 年 1 月至 2021 年 4 月，纳入 259 例接受手术治疗的高血压 TBAD 患者。98 例患者接受强化 BP 控制，目标收缩压（SBP）<120mmHg；161 例患者接受标准 BP 控制，目标 SBP 为 120-140mmHg。比较两组患者的临床资料。
强化 BP 控制组术后急性肾损伤（AKI）发生率明显高于标准 BP 控制组（21/98，21.4%比 14/161，8.7%，=0.004）。与标准组相比，强化组每日使用的降压药更多（1.9 比 1.5，<0.001）。强化组三联药物组合治疗更频繁（38.8%比 14.3%，<0.001），血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB；67.3%比 44.7%，0.001）和噻嗪类利尿剂（44.9%比 18.0%，<0.001）更常用。
强化 BP 控制治疗增加了 AKI 的发生率，增加了降压药的使用，但并未降低接受手术修复的 TBAD 患者的手术死亡率和晚期死亡率。
