и-АПФ после АКШ

[DRUG_]

У кого-нибудь есть ссылки по данной теме? Поделитесь, пожалуйста!
Спасибо:-)

[Korzun]

В моей статье, расположенной [Ссылки доступны только зарегистрированным пользователям ] есть таблица 6 с большим перечнем trials с их кратким описанием и литературным источником, среди которых встречается и АКШ.
Кроме того, рекомендую самостоятельно поискать в медлайне.

[DRUG_]

Уже поискал!
Но все равно ОГРОМНОЕ спасибо)))

[Dr.Vad]

Rady MY, Ryan T.
The effects of preoperative therapy with angiotensin-converting enzyme inhibitors on clinical outcome after cardiovascular surgery.
Chest. 1998 Aug;114(2):487-94.

[Ссылки доступны только зарегистрированным пользователям ]

Eur J Cardiothorac Surg. 1999 Jan;15(1):55-60.
Tolerance to ACE inhibitors after cardiac surgery.
Manche A, Galea J, Busuttil W.
Department of Cardiothoracic Surgery, St. Luke's Hospital, Guardamangia, Malta.

OBJECTIVES: Several studies have shown angiotensin-converting enzyme (ACE) inhibitors to confer significant mortality and morbidity benefits in heart failure. First-dose hypotension may necessitate interruption of such therapy. This is more likely to occur if the ACE inhibitor is administered early after coronary artery bypass grafting (CABG). The purpose of this study was to analyse the haemodynamic tolerance to early post-operative treatment with perindopril and enalapril in patients with impaired renal and ventricular function. METHODS: Eighty one consecutive CABG patients with a previous myocardial infarction, impaired pre-operative left ventricular ejection fraction (LVEF) on ventriculography and moderately impaired renal function (serum creatinine of 115-150 micromol/l) were randomised into three groups to receive oral placebo, perindopril (4 mg) or enalapril (5 mg) once daily. Groups were subdivided into those with mild ventricular dysfunction (LVEF = 35-65%, n = 20) and significant ventricular dysfunction (LVEF < 35%, n = 7). Exclusion criteria included oliguria (<0.5 ml/kg per h) or inotrope dependance at the point of entry on the first post-operative day. Intolerance to ACE inhibitor was defined as hypotension (<95 mmHg systolic blood pressure or a decrease exceeding 25 mmHg in systolic blood pressure) leading to oliguria (<0.5 ml/kg per h) which was unresponsive to intravenous furosemide (20 mg). In such cases ACE inhibitor treatment was discontinued and patients commenced on dopamine. RESULTS: In the groups with mild ventricular dysfunction (LVEF = 35-65%) perindopril was discontinued in 1/20 and enalapril in 4/20 patients (P = n.s). However, in the groups with significant ventricular dysfunction (LVEF < 35%) perindopril was discontinued in 2/7 and enalapril in 7/7 patients (P = 0.02). CONCLUSION: Our results suggest that after CABG, patients with moderately impaired renal function and significant ventricular dysfunction do not tolerate ACE inhibitors well when these were commenced on the first post-operative day. However, perindopril was associated with less haemodynamic deterioration than enalapril and consequently may be advantageous in this setting.


Pigott DW, Nagle C, Allman K, Westaby S, Evans RD.
Effect of omitting regular ACE inhibitor medication before cardiac surgery on haemodynamic variables and vasoactive drug requirements.
Br J Anaesth. 1999 Nov;83(5):715-20.

[Ссылки доступны только зарегистрированным пользователям ]

Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, Barash PG, Hsu PH, Mangano DT; Investigators of the Ischemia Research and Education Foundation; Multicenter Study of Perioperative Ischemia Research Group.
A multicenter risk index for atrial fibrillation after cardiac surgery.
JAMA. 2004 Apr 14;291(14):1720-9.

Conversely, reduced risk (for AF) was associated with postoperative administration of beta-blockers (OR, 0.32; 95% CI, 0.22-0.46), ACE inhibitors (OR, 0.62; 95% CI, 0.48-0.79), potassium supplementation (OR, 0.53; 95% CI, 0.42-0.68), and nonsteroidal anti-inflammatory drugs (OR, 0.49; 95% CI, 0.40-0.60).