Badid C, Chambrier C, Aouifi A, Boucaud C, Boulétreau P
Département d'anesthésie-réanimation, hospices civils de Lyon, Hôtel-Dieu, France.
Ann Fr Anesth Reanim. 1997;16(1):55-7. doi: 10.1016/s0750-7658(97)84279-7.
A 72-year-old man experienced a postoperative acute renal failure (ARF) from a nonsteroidal anti-inflammatory drug (NSAID) and an angiotensin converting enzyme inhibitor (ACEI) intake and promoted by an unrecognized myeloma, peroperative hypotension and hormonal response to surgical stress. This drug combination can result in ARF through a fall of glomerular filtration by combined renal blood flow changes: NSAID inhibit vasodilation by renal prostaglandins, and the vasoconstrictor effect on the efferent arteriole is inhibited by the ACEI. Nephrotoxicity during the simultaneous use of ACEI and NSAID is increased by other risk factors of renal insufficiency such as ageing, preexisting renal disease and hypovolaemia. In these cases, a preventive therapy should be considered.
一名72岁男性因服用非甾体抗炎药（NSAID）和血管紧张素转换酶抑制剂（ACEI）后出现术后急性肾衰竭（ARF），未被识别的骨髓瘤、术中低血压及手术应激的激素反应也促使了该病的发生。这种药物组合可通过肾血流变化导致肾小球滤过率下降，进而引发ARF：NSAID抑制肾前列腺素介导的血管舒张，而ACEI抑制对出球小动脉的血管收缩作用。同时使用ACEI和NSAID时，肾功能不全的其他危险因素（如年龄、既往肾病和血容量不足）会增加肾毒性。在这些情况下，应考虑预防性治疗。
