急诊手术老年高血压患者手术当日使用血管紧张素转换酶抑制药/血管紧张素受体阻滞药对围手术期心脑血管事件的影响:倾向评分匹配分析  

Effect of continuing preoperative angiotensin converting enzyme inhibitor or angiotensin receptor blocker on perioperative cardiovascular and cerebrovascular events in elderly patients with hypertension undergoing emergency surgery:a propensity score matc

作　　者：杨勇勇 李敏 林文谦 梁敏[1] 陈鹭[1] YANG Yongyong;LI Min;LIN Wenqian;LIANG Min;CHEN Lu(Department of Anesthesiology,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou,Fujian 350212;Department of Anesthesiology and Perioperative Medicine,900 Hospital of the Joint Logistic Support Force;Department of Anesthesiology,the First Affiliated Hospital,Fujian Medical University)

机构地区：[1]福建医科大学附属第一医院滨海院区国家区域医疗中心麻醉科,福建福州350212 [2]中国人民解放军联勤保障部队第九〇〇医院麻醉与围术期医学科 [3]福建医科大学附属第一医院麻醉科

出　　处：《中华高血压杂志（中英文）》2024年第11期1057-1064,共8页Chinese Journal of Hypertension

基　　金：福建省自然科学基金面上项目(2022J01688);福建医科大学启航基金(2022QH1079)。

摘　　要：目的评价和比较急诊手术老年高血压患者手术当日使用血管紧张素转换酶抑制药(ACEI)/血管紧张素受体阻滞药(ARB)对围手术期心脑血管事件的影响。方法回顾分析2022年12月至2023年8月在福建医科大学附属第一医院行急诊手术且合并高血压的老年患者723例,年龄60~96岁,美国麻醉医师协会(ASA)分级ⅡE~ⅣE级。采用倾向性评分法按1∶1匹配分为两组,即手术当日使用ACEI/ARB组和手术当日未使用ACEI/ARB组。匹配因素包括性别、年龄、ASA分级、麻醉方式、原发疾病、高血压分级、脑血管事件史、合并内科疾病、术前活动耐量、是否规律用药、是否感染新型冠状病毒及预后等。分析术中和术后24 h严重低血压以及术后6月内心脑血管事件发生率和全因死亡率。结果共206例患者匹配成功,发生术中及术后24 h内严重低血压患者117例(56.80%),其中手术当日使用ACEI/ARB组82例(79.62%),手术当日未使用ACEI/ARB组35例(33.98%),且手术当日使用ACEI/ARB组严重低血压累计时间长于手术当日未使用ACEI/ARB组[15(5,20)比0(0,10)min;W=-3160,P<0.01]。亚组分析结果表明:高龄(年龄>75岁)、术前活动耐量<4代谢当量、新型冠状病毒感染后3月内、行开放手术的患者手术当日使用ACEI/ARB术中和术后24 h严重低血压发生风险高于未使用ACEI/ARB(均P<0.05)。两组患者术后6月内心肌梗死和脑卒中发生率,以及全因死亡率差异无统计学意义(均P>0.05)。结论手术当日使用ACEI/ARB增加合并高血压的急诊手术老年患者术中和术后24 h严重低血压风险,但对术后6月内心肌梗死和脑卒中发生率,以及全因死亡率无影响。Objective To evaluate and analyze the impact of continuing preoperative angiotensin converting enzyme inhibitor(ACEI)or angiotonin receptor blocker(ARB)on perioperative cardiovascular and cerebrovascular events in elderly patients with hypertension undergoing emergency surgery.Methods A total of 723 elderly hypertensive patients,aged 60 to 96 years,American Society of Anaesthesiologist(ASA)ⅡE toⅣE,who underwent emergency surgery during December 2022 to August 2023 were retrospectively screened.Patients were assigned to ACEI/ARB continuation or discontinuation on the day of surgeryusing 1∶1 propensity score matching method.Factors including gender,age,ASA classification,anesthesia method,primary disease,hypertension classification,history of cerebrovascular events,comorbid internal diseases,preoperative activity tolerance,regular medication use,history of coronavirus disease 2019(COVID-19)and prognosis were considered when matching by propensity score.The incidence of cardiovascular and cerebrovascular events(severe hypotension,malignant arrhythmia,myocardial infarction,stroke)and all-cause mortality within 6 months after operation were analyzed.Results A total of 206 patients were successfully matched.Among them,117 patients(56.80%)suffered from severe hypotension during operation and within 24 hours after operation,including 82 patients(79.62%)in the ACEI/ARB continuation group and 35 patients(33.98%)in the ACEI/ARB discontinuation group.The cumulative duration of severe hypotension was significantly longer in ACEI/ARB continuation group than in ACEI/ARB discontinuation group[15(5,20)vs 0(0,10)min;W=-3160,P<0.01].Subgroup analysis indicated that in the patients who were older(age>75),had preoperative activity tolerance<4 metabolic equivalent,had COVID-19 infection within 3 months,or underwent open surgery,ACEI/ARB continuation on the day of surgery led to an increased risk of severe perioperative hypotension compared to discontinuation.There were no statistically significant differences between the two gro

关 键 词：血管紧张素转换酶抑制药 血管紧张素受体阻滞药 高血压 老年 低血压 急诊手术 

分 类 号：R544.1[医药卫生—心血管疾病]