我感觉ACEI类药物手术前用椎管内麻醉可能出现低血压，我们有好几例了，可麻醉教科书直说利血平和ß受体阻滞剂不能用，前者使儿茶酚胺衰竭，手术中血压下降很难提压，后者由于ß受体“反跳”，可引起高血压。ACEI类药物我推测主要是通过体液调节使减少血管紧张素Ⅱ的生成，减少缓激肽的水解，导致血管舒张、血容量减少血压下降，手术前进食水往往血容量不足，导致双重降压效应。外科住院高血压病人经常口服北京降压0好，为复方利血平胺苯喋喋。含有利血平和利尿剂，所以最好不用，此外长期服用此类药物要注意利尿剂引起低血钾和血容量不足。作者: qiuhuanrong 时间: 2010-3-13 07:50
We routinely administer all antihypertensive drugs preoperatively, except ACE inhibitors or angiotensin II antagonists (AIIAs), which we tailor to the individual patient. Coriat and colleagues[122] found that ACE inhibitors were associated with hypotension in 100% of patients during induction versus about 20% in whom ACE inhibitors were withheld on the morning of surgery. Bertrand and coworkers performed a prospective randomized study in which it was demonstrated that more severe hypotensive episodes requiring vasoconstrictor treatment occur after induction of general anesthesia in patients chronically treated with an AIIA and receiving the drug on the morning before surgery than in those in whom AIIAs were discontinued on the day before surgery.[123] Kheterpal and colleagues performed a propensity-matched analysis of 12,381 noncardiac surgery cases.[124] Patients with chronic ACE inhibitor/angiotensin receptor blocker and diuretic therapy showed more periods with a mean arterial BP lower than 70 mm Hg, periods with a 40% decrease in systolic BP, periods with a 50% decrease in systolic BP, and vasopressor boluses than patients receiving diuretic therapy alone did. If these drugs are continued, vasopressin is the drug of choice for refractory hypotension. Although the long-term adverse effects of withholding therapy on the morning of surgery were not assessed, we withhold therapy until either oral fluid is able to be consumed (ambulatory patients) or we can convert to intravenously or nasogastrically administered alternatives (patients who remain NPO postoperatively). We even administer the patient's chronic diuretics on the morning of surgery because the major effect of diuretics after 1 week of therapy is arteriolar vasodilation and assessment of urine output may be inaccurate if the diuretic is abruptly discontinued on the morning of surgery.摘自Miller Anestehsia.7th edition.作者: 小麻将123 时间: 2017-8-31 18:37
直到手术当天早上