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판막수술을 시행 받는 환자에서 레닌-안지오텐신계 길항제가 체외순환 후 요골-대퇴동맥압 간의 차이에 미치는 영향

Other Titles
 Effect of Preoperative Renin-Angiotensin System Antagonists on the Difference between Radial and Femoral Arterial Pressure after Cardiopulmonary Bypass in Patients Undergoing Valvular Heart Surgery 
 김대희  ;  곽영란  ;  방서욱  ;  차재호  ;  심재광  ;  이종화 
 KOREAN JOURNAL OF ANESTHESIOLOGY, Vol.53(2) : 199-205, 2007 
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Background Femoral to radial arterial pressure gradient (ΔP) often develops after cardiopulmonary bypass (CPB) where radial artery pressure (RAP) does not reflect the actual perfusion pressure. Renin-angiotensin system antagonists (RAS-A) are increasingly prescribed preoperatively which causes vasodilation and vascular remodeling. We evaluated the effect of RAS-A medication on ΔP after CPB in patients undergoing valvular heart surgery. Methods Eighty-five patients scheduled for elective valvular heart surgery for regurgitant lesions were divided into two groups: the RAS-A group, in which patients were on RAS-A preoperatively (n = 52) and the control group (n = 33). Hemodynamic variables including RAP, femoral arterial pressure (FAP), body temperature, and hematocrit were recorded at after induction of anesthesia, pre-and post-CPB and sternum closure. Results After CPB, systolic ΔP was significantly greater in the RAS-A group than in the control group. Nine (27%) and 36 (69%) patients after CPB, and 6 (18%) and 23 (44%) patients after sternum closure developed systolic ΔP more than 10 mmHg, in the control and RAS-A group, respectively, which were statistically significant. Body temperature, hematocrit and systemic vascular resistance index were not different between groups. Conclusions Preoperative treatment with RAS-A resulted in clinically significant ΔP after cardiopulmonary bypass in about 70% of patients undergoing valvular heart surgery. Concomitant monitoring of FAP with RAP might be helpful to prevent inadequate vasopressor therapy guided by inaccurate RAP after CPB in this subset of patients.
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1. College of Medicine (의과대학) > Dept. of Anesthesiology and Pain Medicine (마취통증의학교실) > 1. Journal Papers
Yonsei Authors
Kwak, Young Lan(곽영란) ORCID logo https://orcid.org/0000-0002-2984-9927
Bang, Sou Ouk(방서욱)
Shim, Jae Kwang(심재광) ORCID logo https://orcid.org/0000-0001-9093-9692
Lee, Jong Wha(이종화)
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