Use of intraoperative vasoactive agents.

5-Aminolevulinic acid hydrochloride (5-ALA), a photodynamic diagnostic agent, visualizes bladder cancer. Previous research has indicated that preoperative intake of 5-ALA leads to a higher incidence of hypotension. Particularly in patients with hypertension, suggestions include discontinuing antihypertensive medications on the morning of surgery to prevent hypotension. However, the effects of antihypertensive drugs on hypotension in patients taking 5-ALA before surgery remains unexamined. We conducted a single-center observational study that included patients aged 20 and above who were regularly taking antihypertensives and underwent transurethral resection of bladder tumors (TURBT) after taking 5-ALA. Patients who took antihypertensives on the morning of surgery were defined as the continued group, whereas those who did not were defined as the discontinued group. Hypotension was defined as a mean blood pressure (MBP) of less than 65 mmHg for 20 min or longer. To adjust for confounding factors, we used propensity scores for inverse probability weighting and performed modified Poisson regression analysis to calculate risk ratios (RRs) and 95% confidence intervals (CIs). We analyzed 132 cases. The crude incidence of hypotension was higher in the continued group compared to the discontinued group (33/51 [64.7%] vs 38/81 [46.9%]; RR 1.38, 95% CI 1.01–1.88; p = 0.041). However, no significant difference was observed between groups after adjustment (RR 1.05, 95% CI 0.66–1.68). In conclusion, the adjusted results suggested no significant association between the continuation of antihypertensive medication and the incidence of intraoperative hypotension. No substantial justification was provided for routinely discontinuing antihypertensive medications.盐酸5-氨基酮戊酸（5-Aminolevulinic acid hydrochloride, 5-ALA）是一种光动力诊断剂，可用于膀胱癌的显像。既往研究表明，术前口服5-ALA会增加低血压的发生率；对于高血压患者，既往建议于手术当日晨起停用降压药物以预防低血压发生。然而，术前服用5-ALA的患者中，降压药物对低血压发生的影响尚未得到研究。本研究开展了一项单中心观察性研究，纳入年龄≥20岁、规律服用降压药物且在服用5-ALA后接受经尿道膀胱肿瘤切除术（Transurethral resection of bladder tumors, TURBT）的患者。将手术当日晨起仍服用降压药物的患者定义为持续给药组，未服用者定义为停药组。低血压定义为平均动脉压（mean blood pressure, MBP）低于65 mmHg且持续时长≥20分钟。为校正混杂因素，本研究采用倾向得分逆概率加权法，并通过改良泊松回归分析计算风险比（risk ratios, RRs）及95%置信区间（confidence intervals, CIs）。本研究共纳入132例病例。未校正的低血压发生率在持续给药组高于停药组（33/51 [64.7%] vs 38/81 [46.9%]; RR 1.38, 95% CI 1.01–1.88; p = 0.041）。但经校正后，两组间未观察到显著差异（RR 1.05, 95% CI 0.66–1.68）。综上，校正后的分析结果提示，持续服用降压药物与术中低血压的发生率无显著关联。目前尚无充分依据支持常规停用术前降压药物。