围手术期肾素血管紧张素系统阻滞剂的使用对心脏手术后急性肾损伤影响的研究进展  

Research progress on the effect of perioperative renin-angiotensin system blockers on acute kidney injury after cardiac surgery

作　　者：张月 雷翀 Zhang Yue;Lei Chong(Graduate School Office,Xi'an Medical University,Xi'an 710068,China;Department of Anesthesiology and Perioperative Medicine,the First Affiliated Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]西安医学院研究生处,西安710068 [2]空军军医大学第一附属医院麻醉与围术期医学科,西安710032

出　　处：《中国医药》2025年第3期443-448,共6页China Medicine

基　　金：国家自然科学基金(81970448);空军军医大学临床研究项目(2021LC2202)。

摘　　要：心脏手术后的相关并发症很常见,并且对患者的临床预后具有重要影响。因心脏疾病需要接受心血管手术的患者,常合并缺血性心脏病、高血压病和糖尿病等,故此类患者常需长期服用肾素血管紧张素系统阻滞剂,即血管紧张素转换酶抑制剂(ACEI)和/或血管紧张素Ⅱ受体拮抗剂(ARB)类药物。针对有ACEI/ARB类药物长期服用史的患者术前是否应停用此类药物以及何时停用,目前围手术期的用药管理指南中尚未达成共识。已发表的临床试验和观察性研究的结果甚至相互矛盾。在本篇综述中,我们将讨论ACEI/ARB类药物在心脏手术围手术期中的应用,侧重于其使用对术后肾脏并发症的影响,以期为服用此类药物的患者提供明确的临床用药指导。Complications after cardiac surgery are common and have a significant impact on the clinical prognosis of patients.Patients who need cardiovascular surgery due to heart disease are often complicated with ischemic heart disease,hypertension and diabetes.Therefore,these patients often need to take long-term renin-angiotensin system blockers,namely angiotensin-converting enzyme inhibitors(ACEI)and/or angiotensinⅡreceptor blockers(ARB)drugs.At present,there is no consensus on whether and when ACEI/ARB should be discontinued before surgery in patients with a history of long-term use of ACEI/ARB drugs.Published clinical trials and observational studies even have conflicting results.In this review,we will discuss the application of ACEI/ARB drugs in the perioperative period of cardiac surgery,focusing on the effect of their use on postoperative renal complications,in order to provide clear clinical guidance for patients taking these drugs.

关 键 词：心脏手术 血管紧张素转换酶抑制剂 血管紧张素Ⅱ受体拮抗剂 急性肾损伤 

分 类 号：R61[医药卫生—外科学]