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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Effect of enalaprilat on postoperative hypertension after surgical repair of coarctation of the aorta.
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Effect of enalaprilat on postoperative hypertension after surgical repair of coarctation of the aorta.

机译：依那普利拉对主动脉缩窄手术修复后高血压的影响。

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OBJECTIVE: Hypertension in pediatric patients after surgical repair of coarctation of the aorta can be difficult to control and may lead to morbidity. The renin-angiotensin system mediates at least part of this hypertension. Enalaprilat, the only intravenous angiotensin-converting enzyme inhibitor, is used to treat hypertension in pediatric patients in other settings. However, its effect on postoperative hypertension during the early postoperative period in patients undergoing surgical repair of coarctation of the aorta is unknown. DESIGN: Prospective, randomized, double-blind study. SETTING: Operating room and the pediatric intensive care unit. PATIENTS: Fourteen consecutive pediatric patients between the ages of 1 and 18 yrs scheduled to undergo surgical repair of coarctation of the aorta. INTERVENTIONS: Patients were randomized to receive enalaprilat or saline placebo. Infusions were begun intraoperatively within 15 mins of aortic repair and repeated every 6 hrs. MEASUREMENTS AND MAIN RESULTS: Plasma renin activity was measured at baseline and on postoperative day 1. Blood pressure was determined at 30 mins and at 2, 4, and 6 hrs after infusion and scored relative to the preoperative blood pressure. The blood pressure in the enalaprilat group was consistently lower at 30 mins, 2 hrs, and 4 hrs after infusion (p <.05), but not at 6 hrs. Plasma renin activity was significantly lower in the placebo group on postoperative day 1. Length of stay in the pediatric intensive care unit trended shorter in the treated group. CONCLUSIONS: Conclusions are limited by a small cohort. Angiotensin-converting enzyme inhibitor therapy resulted in improved blood pressure control after coarctation repair. Further improvement of blood pressure control may be achievable by use of a larger dose of enalaprilat or a 4-hr enalaprilat-dosing interval.
机译：目的：小儿手术修复主动脉缩窄后的高血压可能难以控制，并可能导致发病。肾素-血管紧张素系统介导该高血压的至少一部分。依那普利拉是唯一的静脉血管紧张素转化酶抑制剂，用于治疗其他情况下的小儿高血压。然而，在手术修复主动脉缩窄的患者中，其对术后早期高血压对术后高血压的影响尚不清楚。设计：前瞻性，随机，双盲研究。地点：手术室和儿科重症监护室。患者：计划接受外科手术修复主动脉缩窄的年龄在1至18岁之间的14名连续儿科患者。干预措施：患者被随机分配接受依那普利拉或生理盐水安慰剂治疗。术中在主动脉修复后15分钟内开始输注，每6小时重复一次。测量和主要结果：在基线和术后第1天测量血浆肾素活性。在输注后30分钟，2、4和6小时测定血压，并相对于术前血压进行评分。依那普利拉组的血压在输注后30分钟，2小时和4小时始终较低（p <.05），但在6小时时并未降低。术后第1天，安慰剂组的血浆肾素活性显着降低。小儿重症监护室的住院时间在治疗组趋于缩短。结论：结论受一小群人的限制。缩窄修复后，血管紧张素转换酶抑制剂治疗可改善血压控制。通过使用较大剂量的依那普利拉或4小时依那普利拉给药间隔，可以实现血压控制的进一步改善。

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