肾病患者使用ACEI类降压药，有何注意事项

2018-08-14 佚名江苏省人民医院肾内科

我们常见的降压药物种类包括血管紧张素转化酶抑制（ACEI，如卡托普利、伊那普利、雷米普利），血管紧张素Ⅱ受体阻断剂，α受体阻滞剂，β受体阻滞剂，钙离子拮抗剂，利尿剂。其中，血管紧张素转化酶抑制剂（ACEI）通过抑制血管紧张素II生成，阻断肾素-血管紧张素-醛固酮系统，抑制缓激肽降解、增强缓激肽效应。不仅可降压，同时还可减少心肌重构，改善心血管病患者预后。

我们常见的降压药物种类包括血管紧张素转化酶抑制（ACEI，如卡托普利、伊那普利、雷米普利），血管紧张素Ⅱ受体阻断剂，α受体阻滞剂，β受体阻滞剂，钙离子拮抗剂，利尿剂。其中，血管紧张素转化酶抑制剂（ACEI）通过抑制血管紧张素II生成，阻断肾素-血管紧张素-醛固酮系统，抑制缓激肽降解、增强缓激肽效应。不仅可降压，同时还可减少心肌重构，改善心血管病患者预后。

AECI在肾脏病的治疗中也具有降低系统高血压、减少蛋白尿排泄、延缓肾损害进展等优势，已被诸多临床试验所证实。但肾脏病人使用ACEI治疗需更加谨慎。

使用原则

从小剂量开始应用，然后逐渐加量将血压控制于合理范围，且需限制食盐摄入。

副作用

1. 咳嗽：血中缓激肽、前列腺素等物质增高引发咳嗽

2. 血清肌酐升高：扩张肾小球出球小动脉作用大于入球小动脉，肾小球内压力减低致肾脏排泄降低

3. 血钾升高：醛固酮正常情况下发挥保钠排钾的作用，当其受到抑制时血钾排泄减少

4. 其它：过敏反应、粒细胞减少、畸胎等

注意事项

1. 双侧肾动脉狭窄者禁用ACEI，单侧肾动脉狭窄者需从小剂量用起，并密切监测血压及血肌酐变化，因此对于怀疑肾动脉狭窄者应在用药前完善肾动脉 IBD%E8%AF%8A%E6%B2%BB%E8%BF%87%E7%A8%8B%E4%B8%AD%E7%9A%84%E8%AF%84%E4%BC%B0-Part%204" target="_blank">B超检查

2. 慢性肾功能不全患者应用ACEI需谨慎，宜选用肝肾双通道排泄药物，并根据肾功能情况调整剂量，当血肌酐>265umol/L时是否仍能使用ACEI存在争议

3. 服用ACEI期间应密切监测血肌酐及血钾水平变化，尤其在开始服药的2个月内最好每1-2周复查，如发现二者水平升高，应及时调整治疗方案

4. ACEI与促红素、非甾体类抗炎药等合用时可能影响单药疗效

5. 血透患者用药过程中需关注透析清除率及过敏反应

6. 孕妇禁用AECI，可致畸胎

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2019-07-21 shanyongle

#ACE#

31 0
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2019-07-03 gostraight

#肾病患者#

34 0
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2019-02-26 xlwang2691

#注意事项#

42 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Aug 15 22:32:02 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338642, encodeId=f2b533864278, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Aug 15 06:07:50 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338620, encodeId=7c5433862058, content=不错的文章值得推荐一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04f22055142, createdName=131****2916, createdTime=Tue Aug 14 23:00:39 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338600, encodeId=349033860088, content=学习了，谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Aug 14 22:13:03 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338581, encodeId=729a33858141, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Tue Aug 14 20:38:47 CST 2018, time=2018-08-14, status=1, ipAttribution=)]
2018-08-19 1230629fm57暂无昵称

学习

65 0
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createdName=gostraight, createdTime=Wed Jul 03 01:21:00 CST 2019, time=2019-07-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1906746, encodeId=bf071906e46ee, content=<a href='/topic/show?id=6440650062f' target=_blank style='color:#2F92EE;'>#注意事项#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65006, encryptionId=6440650062f, topicName=注意事项)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e6ac207, createdName=xlwang2691, createdTime=Tue Feb 26 11:21:00 CST 2019, time=2019-02-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=339480, encodeId=e11633948017, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, 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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Aug 15 22:32:02 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338642, encodeId=f2b533864278, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Aug 15 06:07:50 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338620, encodeId=7c5433862058, content=不错的文章值得推荐一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04f22055142, createdName=131****2916, createdTime=Tue Aug 14 23:00:39 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338600, encodeId=349033860088, content=学习了，谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Aug 14 22:13:03 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338581, encodeId=729a33858141, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Tue Aug 14 20:38:47 CST 2018, time=2018-08-14, status=1, ipAttribution=)]
2018-08-16 经常头晕

#降压#

29 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Aug 15 22:32:02 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338642, encodeId=f2b533864278, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Aug 15 06:07:50 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338620, encodeId=7c5433862058, content=不错的文章值得推荐一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=04f22055142, createdName=131****2916, createdTime=Tue Aug 14 23:00:39 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338600, encodeId=349033860088, content=学习了，谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/xkvRjYnJzzRJ2R0y7VhicibvkjPWHjIMmu4ZpKnE9cWAu4lVicS3uDUCfF4M4JWvrkrYfpb2KehPV0Ee29tPqyPEebBUibiaKhnvD/0, createdBy=f8412001184, createdName=惠映实验室, createdTime=Tue Aug 14 22:13:03 CST 2018, time=2018-08-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338581, encodeId=729a33858141, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Tue Aug 14 20:38:47 CST 2018, time=2018-08-14, status=1, ipAttribution=)]
2018-08-15 1e1b8538m79(暂无匿称)

不错的文章值得拥有哦

58 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Aug 15 22:32:02 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338642, encodeId=f2b533864278, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Aug 15 06:07:50 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338620, encodeId=7c5433862058, content=不错的文章值得推荐一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], 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createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Tue Aug 14 20:38:47 CST 2018, time=2018-08-14, status=1, ipAttribution=)]
2018-08-15 哈哈869

学习了

57 0
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topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=eff51996281, createdName=1e1b8538m79(暂无匿称), createdTime=Wed Aug 15 22:32:02 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338642, encodeId=f2b533864278, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKcmgibQ4oCrK7Z6f4CvMcs4k7QUGCkhopcGxvxaBfVciadECSIwaRVttllIOEKumpEaRrq5PoOUxow/0, createdBy=e3bb2081203, createdName=哈哈869, createdTime=Wed Aug 15 06:07:50 CST 2018, time=2018-08-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=338620, encodeId=7c5433862058, content=不错的文章值得推荐一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[], 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2018-08-14 131****2916

不错的文章值得推荐一下

60 0
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2018-08-14 惠映实验室

学习了，谢谢分享。

0 0
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2018-08-14 哈哈869

学习了

27 0

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