Colson P
Department of Anesthesiology, Centre Hospitalo-Universitaire, Montpellier, France.
J Cardiothorac Vasc Anesth. 1993 Dec;7(6):734-42. doi: 10.1016/1053-0770(93)90063-q.
Besides the long-term regulation of extracellular fluid volume, the RAS plays an important physiologic role in maintaining venous return and blood pressure during acute hemodynamic stresses. ACE inhibitors may therefore alter venous return and cardiac output regulation during anesthesia and surgery. This may be regarded as a drawback of ACE inhibition when other factors interfere with cardiovascular homeostasis; deleterious hemodynamic events may therefore occur when blood volume is decreased, which may be frequent during cardiovascular anesthesia and surgery. However, the alternative solution should not be to stop ACE inhibitors preoperatively. This would allow recovery of RAS control of blood pressure, but at the expense of some regional circulations. From this point of view, preliminary results from early studies during cardiovascular anesthesia and surgery showing redistribution of regional blood flow with inhibition of ACE are encouraging; whether postoperative outcome can be improved deserves further studies. At this time, the evidence is that ACE inhibition does not allow the anesthesiologist to be tolerant of hypovolemia.
除了对细胞外液量的长期调节作用外，肾素-血管紧张素系统（RAS）在急性血流动力学应激期间维持静脉回流和血压方面发挥着重要的生理作用。因此，血管紧张素转换酶（ACE）抑制剂可能会在麻醉和手术期间改变静脉回流和心输出量的调节。当其他因素干扰心血管稳态时，这可能被视为ACE抑制的一个缺点；因此，当血容量减少时，可能会发生有害的血流动力学事件，而这在心血管麻醉和手术期间可能很常见。然而，替代解决方案不应是在术前停用ACE抑制剂。这将恢复RAS对血压的控制，但代价是牺牲一些局部循环。从这一角度来看，心血管麻醉和手术早期研究的初步结果表明，ACE抑制会导致局部血流重新分布，这是令人鼓舞的；术后结果是否能够得到改善值得进一步研究。目前，有证据表明ACE抑制并不能让麻醉医生耐受低血容量。
