小腹主动脉动脉瘤的医疗管理
B Timothy Baxter1, Michael C Terrin, Ronald L Dalman
1University of Nebraska Medical Center, Omaha, NE, USA. btbaxter@unmc.edu
Circulation
|April 9, 2008
概括
小腹主动脉动脉瘤 (AAA) 很常见,通常是偶然检测到的. 医疗管理策略,包括多西环素,罗西胺素和他类药物,在减缓AAA增长方面表现有前途,需要进一步研究.
科学领域:
- 心血管医学 心血管医学
- 血管外科 血管外科
- 药理学 药理学是指药理学的学科.
背景情况:
- 腹腔大动脉瘤 (AAA) 是一种普遍的疾病,通常在成像期间因其他原因偶然发现.
- 当前的指导方针建议在动脉瘤直径达到5.05.5厘米时进行手术修复.
- 显著的大多数 (90%) 检测到的AAA低于干预值,需要制定小动脉瘤管理策略.
研究的目的:
- 审查对影响小腹主动脉动脉瘤进展的因素的现有研究.
- 在观察期间为小AAA的医疗管理提出建议.
- 探索潜在的药理干预措施,以防止AAA扩张.
主要方法:
- 审查当前的文献和临床实践指南,包括证据分级 (A,B,C级).
- 对研究血液动力学管理,炎症抑制和蛋白酶抑制的研究进行分析.
- 对特定药物的证据评估,如:普罗普兰诺洛尔,罗克西胺,多克西环素,他类药物,ACE抑制剂和血管激素受体抑制剂.
主要成果:
- 在男性中观察到长达5.5厘米的小动脉瘤是安全的; 甲醇在抑制扩张方面无效 (A级证据).
- рокситромицин或多西环林可能会降低动脉瘤扩张的速度 (B级证据).
- 烟草使用与加速动脉瘤扩张有关;他类药物可能抑制扩张 (B/C级证据).
- 在AAA扩张中,对ACE抑制剂和血管激素受体抑制剂的人类数据有限.
结论:
- 安全抑制AAA扩张的药理学药物可以显著改变当前的治疗模式.
- 进一步的研究是必不可少的,以澄清多克西环素,罗克西胺和他类药物治疗在管理AAA进展中的作用.
- 小AAA的医疗管理有可能防止早期手术干预的需要.
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