术前继续或停止使用肾素-血管紧张素-醛固酮系统抑制剂对腹腔镜手术患者围术期并发症的影响

Effect of preoperative continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors on perioperative complications in patients undergoing laparoscopic surgery

目的评价术前继续或停止使用肾素-血管紧张素-醛固酮系统(RAAS)抑制剂对腹腔镜手术患者术中低血压及围术期并发症的影响。方法纳入在全身麻醉下行腹腔镜手术,并在术前长期使用RAAS抑制剂的高血压患者150例,随机分为2组:术前停用RAAS抑制剂组(C组,n=75)和继续使用RAAS抑制剂组(R组,n=75),C组患者在手术当天停用RAAS抑制剂,R组患者在手术当天继续使用RAAS抑制剂。主要结局指标为术中低血压的发生率,次要结局指标为心律失常、心肌损伤、肾损伤、转入ICU、死亡、切口感染等发生率以及住院天数。结果C组患者术中低血压发生率为65.3%(49/75),R组为84.0%(63/75)(P=0.009)。C组患者中位低血压发生次数为6次,R组为10次(P<0.001)。R组患者低血压持续时间长于C组,中位数差异为2.2 min(P=0.048)。R组患者发生低血压接受治疗后的反应时间同样长于C组,中位数差异为16 s(P=0.005)。2组间心律失常、心肌损伤、肾损伤、转入ICU、死亡、切口感染等发生率以及住院天数的差异均无统计学意义(P>0.05)。结论与术前停止使用RAAS抑制剂相比,术前继续使用RAAS抑制剂增加了术中低血压发生率,但心率失常、心肌损伤、肾损伤、转入ICU、死亡、切口感染等发生率以及住院天数并未增加。

Objective To evaluate the effect of continuing or discontinuing administration of renin-angiotensin-aldosterone system(RAAS)inhibitors before surgery on intraoperative hypotension and perioperative complications in patients undergoing laparoscopic surgery.Methods A total of 150 hypertensive patients undergoing laparoscopic surgery under general anesthesia with long-term use of RAAS inhibitors before surgery were included.They were randomly divided into two groups(n=75):a preoperative discontinuing administration of RAAS inhibitor group(group C)and a continuing use of RAAS inhibitor group(group R).The primary outcome was the incidence of intraoperative hypotension,while the secondary outcomes were the incidence of arrhythmia,myocardial injury,renal injury,ICU transfer,death and wound infection,as well as the length of hospitalization stay.Results The incidence of intraoperative hypotension was 65.3%(49/75)for group C and 84.0%(63/75)for group R(P=0.009).The median number of hypotension occurrence was six times for group C,and ten times for group R(P<0.001).The duration of hypotension in group R was longer than that in group C,with a median difference of 2.2 min(P=0.048).The response time of patients with hypotension in group R was also longer than that in group C,with a median difference of 16 s(P=0.005).There were no statistical differences in the incidence of arrhythmia,myocardial injury,renal injury,ICU transfer,death,wound infection,as well as the length of hospitalization stay between the two groups.Conclusions Compared with discontinuation of RAAS inhibitors before surgery,continued use of RAAS inhibitors increases the incidence of intraoperative hypotension,but no statistical increase is found in the incidence of arrhythmia,myocardial injury,renal injury,ICU transfer,death,and wound infection as well as the length of hospitalization stay.