心臓外科手術前のレニン- 血管新生系阻害剤の中止: メタ解析
Joseph Y Bena Nnang1,2, Ticha B T Tembi3, Samuel G J Fodop1,4
1Research Division, Winners Foundation, Yaounde, Cameroon.
European heart journal
|August 29, 2025
まとめ
非心臓手術の前にレニン- 血管新生系 (RAS) 阻害剤の投与を中止すると,低血圧が低下する可能性があります. しかし,高血圧と主要な臨床結果に関する証拠は不確実であり,慎重な患者管理が必要である.
科学分野:
- 心臓病科
- 麻酔科
- 薬理学について
背景:
- 手術前のレニン- 血管新生系 (RAS) 阻害剤の管理は議論されている.
- 継続は低血圧のリスクを高め,中止は高血圧と心不全のリスクを高めます.
研究 の 目的:
- 非心臓および非血管外科手術を受けた患者のRAS阻害剤の中止と継続を比較する.
- RAS阻害剤の最適な手術前管理戦略を決定する.
主な方法:
- ランダム化制御試験の体系的レビューとメタ解析
- PubMed,Embase,Cochrane CENTRALで 関連する研究について調べました
- 10773人の患者を対象とした5つのRCTを含む.
主要な成果:
- RAS阻害剤の投与を中止すると,手術前低血圧が低下する可能性が高い (RR 0. 81, 95% CI 0. 73- 0. 89).
- 術後の高血圧 (RR1. 38,95%CI 0. 66- 2. 89) に関する証拠は極めて不確実である.
- 急性腎臓損傷,心不全,心筋梗塞,脳卒中,または不律症ではほとんど違いは認められなかった.
結論:
- RAS阻害剤の投与を中止すると,非心臓,非血管外科手術では,手術前低血圧が低下する可能性があります.
- 高血圧および主要な臨床結果に関する証拠は不明である.
- 最適な管理戦略を明確にするためにさらなる研究が必要である.
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