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在外科手术期间使用的雷宁- ангиотензин- 阿尔多斯特系统 (RAAS) 抗体:最新的综述
Raya Nahlawi1, Zoha Majeed2, Issam Motairek2
1Case Western Reserve University School of Medicine, Cleveland, OH.
The American journal of medicine
|January 26, 2026
概括
在外科手术期间持续使用氨酸- ангиотензин- 阿尔多素系统 (RAAS) 抗剂可能会增加低血压风险,但不会恶化主要结果. 对于手术患者,建议采用个性化的RAAS管理方法.
科学领域:
- 心脏病学 心脏病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
背景情况:
- 氨酸-氨酸-阿尔多斯特系统 (RAAS) 抗剂对于控制心血管和脏疾病至关重要.
- 由于低血压和血管的担忧,RAAS对手的外科使用是有争议的.
研究的目的:
- 综合当前的指导方针,证据和关于外科手术期间RAAS抗剂管理的机制性见解.
- 为内科医生提供关于在手术患者中使用RAAS抗剂的决策框架.
主要方法:
- 对指南建议,机制性见解和临床试验数据 (POISE-3,STOP-OR-NOT,SPACE) 的审查.
- 检查RAAS对抗剂,麻醉,液体转移和心血管风险之间的生理相互作用.
主要成果:
- 在外科手术期间持续使用RAAS抗剂可能会增加手术内低血压风险.
- 随着RAAS抗剂治疗的持续,没有观察到重大术后结果的持续恶化.
- 在低心血管风险的患者或高风险的手术中,可以考虑停止治疗.
结论:
- 建议采用个性化,基于证据的方法来治疗外科手术期间的RAAS抗剂.
- 考虑生物标志物 (例如,NT-proBNP) 和新兴疗法 (RNAI,药物基因组学) 是很重要的.
- 讨论了手术后恢复RAAS抗剂治疗的指导.
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