非心脏手术前继续使用与停用肾素-血管紧张素醛固酮系统抑制剂：系统回顾和荟萃分析。

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2024-11-11 DOI:10.1016/j.jclinane.2024.111679

Mushood Ahmed , Eeshal Fatima , Aimen Shafiq , Areeba Ahsan , Eeshal Zulfiqar , Fouad Masood , Raheel Ahmed , Farah Yasmin , Muhammad Sohaib Asghar

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引用次数: 0

摘要

背景：大量接受非心脏手术的患者长期服用血管紧张素转换酶抑制剂（ACEi）或血管紧张素受体阻滞剂（ARB）。目前关于非心脏手术前继续使用或停用肾素-血管紧张素-醛固酮系统抑制剂（RAAS）的指南存在冲突。本荟萃分析旨在评估在非心脏手术前继续使用或停用 RAAS 抑制剂是否会影响围手术期死亡率和并发症：方法：我们在 PubMed/MEDLINE、Embase 和 Cochrane 图书馆中进行了全面的文献检索，以确定符合条件的随机对照试验 (RCT) 和队列研究。采用随机效应模型对临床结果进行评估，以得出带有 95% 置信区间 (CI) 的赔率比 (OR)：分析包括16项研究，共有59105名患者在非心脏手术前服用了RAAS抑制剂。与继续使用 RAAS 抑制剂相比，停用 RAAS 抑制剂可显著降低术中低血压（OR = 0.49；95 % CI = 0.29 至 0.83）和急性肾损伤（AKI）（OR = 0.88；95 % CI = 0.82 至 0.95）的发生率。然而，在降低死亡率（OR = 1.10；95 % CI = 0.86 至 1.40）、主要不良心血管事件（MACE）（OR = 1.27；95 % CI = 0.75 至 2.16）、心肌梗死（OR = 0.83；95 % CI = 0.27 至 2.59）或中风事件（OR = 0.70；95 % CI = 0.36 至 1.36）方面，两组之间没有统计学意义上的显著差异：结论：非心脏手术前停用 RAAS 抑制剂可降低术中低血压和 AKI，但对死亡率和 MACE 的影响不大。

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Continuation versus discontinuation of renin-angiotensin aldosterone system inhibitors before non-cardiac surgery: A systematic review and meta-analysis

Background

A large number of patients undergoing noncardiac surgeries are on long-term use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARBs). The current guidelines regarding the continuation or discontinuation of renin-angiotensin-aldosterone system inhibitors (RAAS) inhibitors before noncardiac surgery are conflicting. This meta-analysis aims to evaluate whether continuing or withholding RAAS inhibitors before noncardiac surgery influences perioperative mortality and complications.

Methods

A thorough literature search was performed across PubMed/MEDLINE, Embase, and the Cochrane Library from their inception up to August 30, 2024 to identify eligible randomized controlled trials (RCTs) and cohort studies. Clinical outcomes were evaluated using a random-effects model to pool odds ratios (ORs) with 95 % confidence intervals (CIs).

Results

The analysis included 16 studies with a total of 59,105 patients on RAAS inhibitors before noncardiac surgery. Withholding RAAS inhibitors was associated with a significantly lower incidence of intraoperative hypotension (OR = 0.49; 95 % CI = 0.29 to 0.83) and acute kidney injury (AKI) (OR = 0.88; 95 % CI = 0.82 to 0.95) than continuing the therapy. However, there was no statistically significant difference in reducing mortality (OR = 1.10; 95 % CI = 0.86 to 1.40), major adverse cardiovascular events (MACE) (OR = 1.27; 95 % CI = 0.75 to 2.16), myocardial infarction (OR = 0.83; 95 % CI = 0.27 to 2.59) or stroke events (OR = 0.70; 95 % CI = 0.36 to 1.36) between the two groups.

Conclusion

Withholding RAAS inhibitors before noncardiac surgery reduces intraoperative hypotension and AKI with nonsignificant effects on mortality and MACE.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.