Bhatt-Mehta V, Deluga K S
Department of Pharmacy, University of Michigan Medical Center, Ann Arbor.
Pharmacotherapy. 1993 Sep-Oct;13(5):515-8.
The use of angiotensin-converting enzyme (ACE) inhibitors in pregnancy has been associated with neonatal morbidity and mortality. The mechanism of renal dysfunction likely is related to fetal hypotension and prolonged decreased glomerular filtration. Six of 14 previously published cases of neonatal renal failure after maternal ACE inhibitor therapy resulted in death. Eight infants survived after peritoneal dialysis, some with residual renal impairment. Serum lisinopril levels and ACE activity in our patient indicate that during the anuric state the drug has an extremely prolonged half-life, and that it is removed by peritoneal dialysis. In view of this prolonged half-life and the drug's continued suppression of ACE activity and renal function, we recommend institution of early dialysis in infants with renal failure after maternal therapy with lisinopril.
孕期使用血管紧张素转换酶（ACE）抑制剂与新生儿发病和死亡有关。肾功能障碍的机制可能与胎儿低血压和肾小球滤过率长期降低有关。先前发表的14例母亲接受ACE抑制剂治疗后新生儿肾衰竭的病例中，有6例导致死亡。8名婴儿在腹膜透析后存活，部分存在残余肾功能损害。我们患者的赖诺普利血清水平和ACE活性表明，在无尿状态下该药物的半衰期极长，且可通过腹膜透析清除。鉴于这种长半衰期以及该药物对ACE活性和肾功能的持续抑制作用，我们建议对母亲接受赖诺普利治疗后出现肾衰竭的婴儿尽早进行透析。
