老年患者俯卧位脊柱手术当天停用或继续使用血管紧张素II受体拮抗剂对血流动力学的影响
贵州医科大学 麻醉与心脏电生理课题组
翻译：柏雪 编辑：田明德 审校：曹莹
前言: 在麻醉诱导至皮肤切开的俯卧位老年脊柱手术患者中，术前停用血管紧张素II受体拮抗剂(ARBs)与持续使用血管紧张素II受体拮抗剂(ARBs)的血流动力学影响尚不清楚。
方法: 本前瞻性研究纳入80例全身麻醉下俯卧位脊柱手术患者，年龄60-79岁，美国麻醉医师学会(ASA) II或III级。仅在术前用药清单中有arb的患者按1:1的比例随机分为两组:a组在手术当天上午继续arb, B组不进行arb。在麻醉诱导过程中，所有患者均输注去甲肾上腺素维持血压在±20%的基线水平。主要观察指标为各组从麻醉诱导至皮肤切口的去甲肾上腺素用量。次要结局包括有创动脉血压和心率的变化、输液量、麻醉药物的用量以及从诱导到皮肤切口的总时间。
结果: 两组患者在人口统计学、输液量、麻醉药物用量、诱导至皮肤切开总时间、血流动力学等各时间点差异无统计学意义(p > 0.05)，去甲肾上腺素用量差异有统计学意义(p < 0.001)。与B组比较，A组去甲肾上腺素使用量明显增加(93.3 ± 29.8 μg vs. 124.1 ± 38.7 μg，p = 0.000)。此外，A组去甲肾上腺素的输注速率（0.06 ± 0.02 μg·kg−1·min−1）也显著高于B组（0.04 ± 0.01 μg·kg−1·min−1）（p = 0.004）。
结论： 我们的研究表明，在接受俯卧位脊柱手术的老年低血压患者中，术前继续使用ARBs的患者在麻醉诱导期间需要更高的去甲肾上腺素输注速率，提示术前继续使用ARBs可能会增加维持血流动力学稳定性的难度。
原始文献来源: Ruimei Yuan, Min Xu, Chunhai Hu, et al. Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients[J]. Front. Med. 11:1352918
Hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers on the day of prone positioning spinal surgery in elderly patients
Introduction: The hemodynamic effects of withholding vs. continuing angiotensin II receptor blockers (ARBs) before surgery in elderly patients undergoing spinal surgery in a prone position during anesthesia induction to skin incision are still unknown.
Methods:In this prospective study, 80 patients undergoing spinal surgery in a prone position with general anesthesia, aged 60–79 years, American Society of Anesthesiologists (ASA) II or III, were enrolled. Patients who had ARBs only in their preoperative medication list were randomly divided into two groups at a 1:1 ratio: In Group A, ARBs were continued on the morning of surgery, while in Group B, they were withhold. Norepinephrine was infused to maintain the blood pressure at the baseline level of ±20% during anesthesia induction in all patients. The primary outcome was the consumption of norepinephrine in each group from anesthesia induction to skin incision. The secondary outcomes include changes in invasive arterial blood pressure and heart rate, the fluid infusion volumes, the amounts of anesthetic drugs, and the total time from induction to skin incision.
Results:There were no significant differences in the demographics, the fluid infusion volumes, the amounts of anesthetic drugs, the total time from induction to skin incision, and hemodynamics at different time points (p > 0.05), while significant differences were found in norepinephrine consumption between the two groups (p < 0.001). Compared with Group B, the consumption of norepinephrine increased significantly in Group A (93.3 ± 29.8 vs. 124.1 ± 38.7 μg, p = 0.000). In addition, the same trend was illustrated in the pumping rate of norepinephrine between Group B (0.04 ± 0.01 μg·kg−1·min−1) and Group A (0.06 ± 0.02 μg·kg−1·min−1) (p = 0.004).
Conclusion: Our study conducted in elderly patients with hypotension undergoing prone spinal surgery demonstrated a greater pumping rate of norepinephrine during anesthesia induction in patients with ARBs continuing before surgery than those withholding, indicating that it was more difficult to maintain hemodynamic stability.