术后抗高血压药物和非心脏手术中的功能衰退和死亡率的影响
Rena Suzukawa1, Shintaro Mandai1, Yuta Nakano1
1Department of Nephrology, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, Tokyo 113-8519, Japan.
European heart journal open
|September 2, 2025
概括
在非心脏手术中,使用血管激素转化酶抑制剂 (ACEis) 或血管激素II受体阻断剂 (ARBs) 与更好的生存和身体功能有关. 这一发现为在手术过程中使用抗高血压药物提供了宝贵的见解.
科学领域:
- 心脏病学
- 麻醉学
- 老年医学
背景情况:
- 术前使用抗高血压药物对非心脏手术患者的结果的影响尚未完全了解.
- 澄清这些关联对于优化患者护理和减少手术风险至关重要.
研究的目的:
- 研究六类抗高血压药物与术后死亡率和身体功能之间的关联.
- 在一个大型的手术队伍中,比较持续和非持续使用抗高血压药物的结果.
主要方法:
- 一个观察性队列研究,利用2014-2019年的行政索赔数据库.
- 包括接受非心脏手术的50岁以上的成年患者,将持续服用抗高血压药物的患者与非持续服用药物的患者进行比较.
- 用多变量逻辑回归模型评估所有原因死亡或功能衰退的风险 (巴特尔指数得分下降≥20%).
主要成果:
- 持续使用抗高血压药物的患者死亡率和功能下降的综合结果为5. 0%,而非使用者为3. 0%.
- 与 thiazide/ thiazide 类利尿剂 (TH) 相比,在单一使用者中,血管酶转化抑制剂 (ACEis) 或血管酶II受体阻断剂 (ARBs) 与较低的风险 (OR,0. 74; 95% CI,0. 62- 0. 89) 相关.
- 与其他类别,特别是通道阻断剂 (CCB) 的ACEis/ ARB组合显示出最低的不良结果风险,特别是在骨科和胃肠道手术中.
结论:
- 在接受非心脏手术的患者中,ACEis或ARB的外科使用与良好的结果相关,包括改善生存和身体功能.
- 这些发现表明,特定的抗高血压药物类别在外科手术期间具有潜在的益处.
- 进一步的研究可能会阐明最佳的抗高血压治疗策略,以加强患者的手术恢复.
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