目的:评价非心脏手术患者术前24h继续服用血管紧张素转换酶抑制剂(ACEI)或血管紧张素Ⅱ受体拮抗剂(ARB)对术后心肌损伤及血压的影响。
方法:单中心,回顾性研究。
方法:手术室和围手术期护理区。
方法:从2012年1月至2022年6月,42,432例服用慢性ACEI/ARB的患者接受了非心脏手术。
方法:在手术前24小时停药ACEI/ARB的患者(停药组,n=31,055)和在手术前24小时继续ACEI/ARB的人(继续组,n=11,377)。
方法:主要结果是非心脏手术(MINS)术后7天内的心肌损伤。MINS定义为术后心肌肌钙蛋白测量值升高,高于参考上限的第99百分位数,具有上升/下降模式。围手术期血压和临床结果是次要结果。
结果:在42,432名患者中,MINS发生在2848例(6.7%)中,是122例(0.3%)患者在30天内死亡的全部原因。持续组的MINS发生率显着高于保留组(847/11,377[7.4%]vs.2001/31,055[6.4%];OR[95%CI]1.17[1.07-1.27];P<0.001)。1:1倾向评分匹配后,每组11,373例患者。在匹配队列中,两组之间的MINS发生率仍然存在显着差异(7.4%vs.6.6%,OR[95%CI]1.14[1.03-1.26];P=0.015)。手术期间平均动脉压<65mmHg的时间平均体重在连续组中明显更高(平均0.11vs.0.09[95%CI的平均差异][0.01-0.03];P<0.001)。然而,其他临床结局和死亡率无显著差异.
结论:术前停用ACEI/ARB可以降低术中低血压和术后心肌损伤的风险,但不影响非心脏手术患者的总体临床结局.
To evaluate the effect of continuing of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) prescriptions 24 h before surgery on postoperative myocardial injury and blood pressure in patients undergoing non-cardiac surgery.
A single-center, retrospective study.
Operating room and perioperative care area.
42,432 patients who had been taking chronic ACEI/ARB underwent non-cardiac surgery from January 2012 to June 2022.
Patients who discontinued ACEI/ARB 24 h before surgery (withheld group, n=31,055) and those who continued ACEI/ARB 24 h before surgery (continued group, n=11,377).
Primary outcome was myocardial injury after non-cardiac surgery (MINS) within 7 days postoperatively. MINS was defined as an elevated postoperative cardiac troponin measurement above the 99th percentile of the upper reference limit with a rise/fall pattern. Perioperative blood pressure and clinical outcomes were secondary outcomes.
Among 42,432 patients, MINS occurred in 2848 patients (6.7%) and was the all-cause of death within 30 days in 122 patients (0.3%). Incidence of MINS was significantly higher in the continued group than the withheld group (847/11,377 [7.4%] vs. 2001/31,055 [6.4%]; OR [95% CI] 1.17 [1.07-1.27]; P<0.001). After 1:1 propensity score matching, 11,373 patients were included in each group. There was still a significant difference for the occurrence of MINS between two groups in matched cohort (7.4% vs. 6.6%, OR [95% CI] 1.14 [1.03-1.26]; P=0.015). Time-average weight of mean arterial pressure <65 mmHg during surgery was significantly higher in the continued group (mean 0.11 vs. 0.09 [95% CI of mean difference] [0.01-0.03]; P<0.001). However, there was no significant difference in other clinical outcomes and mortality.
Withholding ACEI/ARB before surgery was associated with a reduced risk of intraoperative hypotension and postoperative myocardial injury, but it did not affect overall clinical outcomes in patients undergoing non-cardiac surgery.