JACC:ACEI/ARB可预防左室辅助装置相关胃肠道出血

2019-04-21 朱柳媛 中国循环杂志

对于严重心衰患者来说,心脏移植是最好的治疗方案,但由于供体有限,很多患者需要等待。在等待心脏移植的过程中,部分患者需要机械循环支持来改善心功能、提高生活质量,其中左室辅助装置最常用。但是,安装连续流动左室辅助装置也有风险,胃肠道出血就是常见的不良事件,文献报道其发生率为15%~40%,其中高达50%的胃肠道出血与动静脉畸形有关。近期发表在JACC上的一项研究表明,血管紧张素转换酶抑制剂(ACEI)

对于严重心衰患者来说,心脏移植是最好的治疗方案,但由于供体有限,很多患者需要等待。在等待心脏移植的过程中,部分患者需要机械循环支持来改善心功能、提高生活质量,其中左室辅助装置最常用。但是,安装连续流动左室辅助装置也有风险,肠道出血就是常见的不良事件,文献报道其发生率为15%~40%,其中高达50%的肠道出血与动静脉畸形有关。近期发表在JACC上的一项研究表明,血管紧张素转换酶抑制剂(ACEI)和血管紧张素Ⅱ受体拮抗剂(ARB)有助于减少这种胃肠道出血。

作者指出,心衰患者在安装连续流动左室辅助装置后,血管紧张素Ⅱ受体会激活,这可能会促进血管生成。ACEI和ARB可阻断这一过程,从而降低胃肠道出血风险。

不过,该研究是一项观察性、回顾性研究,且样本量较小,其结果还需要进一步研究来证实。

研究者回顾分析了2009~2016年安装Heartmate II连续流动左室辅助装置的111例患者资料,发现平均随访2.1年期间,28%的患者至少出现过一次胃肠道大出血(24小时内至少需要输2个单位浓缩红细胞或导致死亡的胃肠道出血),22%的患者至少出现过一次动静脉畸形相关胃肠道出血。研究显示,在安装左室辅助装置30天内应用ACEI或ARB的患者中,胃肠道大出血(15% vs 31%)和动静脉畸形相关胃肠道出血(8% vs 21%)的发生率明显低于没用这两类药物的患者。进一步分析发现,应用ACEI或ARB可将胃肠道大出血和动静脉畸形相关胃肠道出血风险分别降低57%和63%。ACEI或ARB的这种作用可能还与剂量有关。研究显示,赖诺普利如以≤5 mg剂量应用时,胃肠道大出血风险降低48%,而如以5 mg以上剂量应用时,胃肠道大出血风险可降低72%。在该研究中,67%的患者应用ACEI或ARB。这些患者的基线模型终末期肝病评分和术后30天内肾脏替代治疗发生率均较低,强心药物应用时间较短。

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    2019-06-16 hbwxf
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    2019-09-15 shanyongle
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    2019-04-22 SCI我的梦

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