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首页> 外文期刊>Current opinion in anaesthesiology >Renin-angiotensin system inhibitors and angioedema: Anesthetic implications
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Renin-angiotensin system inhibitors and angioedema: Anesthetic implications

机译：肾素-血管紧张素系统抑制剂和血管性水肿的麻醉意义

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Purpose of review: Angioedema is a serious complication of renin-angiotensin system inhibitor therapy. The incidence is 0.1-0.7%. It consists of nonpitting edema and involves the face and lips. In severe cases, it extends to pharyngeal and laryngeal structures. Recent findings: Decreased degradation of bradykinin and its metabolites is thought to be a culprit. When the angiotensin-converting enzyme is inhibited, bradykinin metabolism is dependent on degradation by neutral endopeptidase, dipeptidyl peptidase IV, and aminopeptidase P. When these enzymes are inhibited, as in treatment of diabetes or in transplant recipients, the incidence of angioedema increases significantly. African-Americans, people over 65, women, and those with a history of smoking are especially at risk. A fiberoptic laryngeal examination should be performed in all patients. Patients with rapid progression of symptoms are at risk for airway compromise. Supportive treatment with steroids and antihistamines is not very effective. Recently, icatibant, a bradykinin receptor antagonist, has been used to successfully shorten the resolution of edema. Summary: Trauma of the airway, especially during difficult intubation, may precipitate severe angioedema. In cases with laryngeal involvement, fiberoptic intubation may be necessary. After the episode of angioedema, lifetime discontinuation of all renin-angiotensin inhibitors may be warranted.
机译：审查目的：血管性水肿是肾素-血管紧张素系统抑制剂治疗的严重并发症。发生率为0.1-0.7％。它由无斑点水肿组成，累及面部和嘴唇。在严重的情况下，它延伸到咽和喉结构。最新发现：缓激肽及其代谢产物的降解降低被认为是罪魁祸首。当血管紧张素转换酶被抑制时，缓激肽的代谢取决于中性内肽酶，二肽基肽酶IV和氨基肽酶P的降解。当这些酶被抑制时，如在糖尿病的治疗或移植受者中，血管性水肿的发生率显着增加。非裔美国人，65岁以上的人，妇女以及有吸烟史的人尤其容易受到威胁。所有患者均应进行纤维喉检查。症状快速发展的患者有气道受损的风险。用类固醇和抗组胺药的支持治疗不是很有效。最近，缓激肽受体拮抗剂icatibant已成功用于缩短水肿的缓解时间。摘要：气道创伤，特别是在插管困难时，可能会导致严重的血管性水肿。在喉部受累的情况下，可能需要进行光纤插管。血管性水肿发作后，可能需要终生停用所有肾素-血管紧张素抑制剂。

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