Chen Junda, Wang Xinghe, Yin Tianyu, Guo Jie, Chen Xiaoyi, Chen Yangyang, Liu Yucheng, Sun Zhengxiu, Wang Keqin, Zhang Yuqi, Zhang Ziqian, Shen Lei, Zhao Linlin, Wu Yan, Liu Su
Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, China.
Crit Care Med. 2025 Oct 22. doi: 10.1097/CCM.0000000000006912.
This study aimed to explore how phenylephrine (PE) and norepinephrine (NE) affect renin-angiotensin-aldosterone system (RAAS) components and postoperative complications in patients undergoing acute abdomen emergency surgery.
A randomized controlled trial.
The Anesthesiology Department at the Affiliated Hospital of Xuzhou Medical University.
We enrolled 156 patients 18 years older who were undergoing emergency acute abdominal surgery under general anesthesia.
Patients were randomized to receive PE (PE group) or NE (NE group) to maintain their mean arterial pressure at 70-80 mm Hg during operation.
The plasma renin level increased in the immediate postoperative period in the NE group (median difference [MD]: 21 μIU/mL (interquartile range [IQR]: 5-51], p = 0.020), but not in the PE group (MD: 7 μIU/mL [IQR: -1 to 33], p = 0.336). However, the plasma renin levels were significantly decreased in both groups at 24 hours postoperation. Furthermore, in both groups, the levels of angiotensin II and aldosterone were reduced at 24 hours postoperation. The upper quartile of the plasma renin level before surgery was associated with higher vasopressor requirements and higher acute kidney injury (AKI) incidence. Furthermore, the groups showed no significant difference in AKI incidence (relative risk [RR]: 1.50 [95% CI, 0.65-3.47], p = 0.569), myocardial injury (RR: 1.11 [95% CI, 0.64-1.93], p = 0.497), and 30-day mortality rate (RR: 1.00 [95% CI, 0.44-2.27], p = 1.000).
PE and NE exert similar effects on RAAS components and postoperative complications. A higher plasma renin level before surgery is associated with greater vasopressor requirement and a higher incidence of postoperative complications.
本研究旨在探讨去氧肾上腺素（PE）和去甲肾上腺素（NE）如何影响急腹症急诊手术患者的肾素 - 血管紧张素 - 醛固酮系统（RAAS）组分及术后并发症。
一项随机对照试验。
徐州医科大学附属医院麻醉科。
纳入156例年龄≥18岁、在全身麻醉下接受急诊急腹症手术的患者。
患者被随机分配接受PE（PE组）或NE（NE组），以在手术期间将平均动脉压维持在70 - 80 mmHg。
NE组术后即刻血浆肾素水平升高（中位数差值[MD]：21 μIU/mL（四分位数间距[IQR]：5 - 51），p = 0.020），而PE组未升高（MD：7 μIU/mL [IQR：-1至33]，p = 0.336）。然而，两组术后24小时血浆肾素水平均显著降低。此外，两组术后24小时血管紧张素II和醛固酮水平均降低。术前血浆肾素水平的上四分位数与更高的血管升压药需求及更高的急性肾损伤（AKI）发生率相关。此外，两组在AKI发生率（相对危险度[RR]：1.50 [95%可信区间，0.65 - 3.47]，p = 0.569）、心肌损伤（RR：1.11 [95%可信区间，0.64 - 1.93]，p = 0.497）及30天死亡率（RR：1.00 [95%可信区间，0.44 - 2.27]，p = 1.000）方面无显著差异。
PE和NE对RAAS组分及术后并发症的影响相似。术前较高的血浆肾素水平与更高的血管升压药需求及更高的术后并发症发生率相关。
