现代皮肤病药物的围手术期管理：以麻醉为重点的叙述性综述

摘要(中文译文)

皮肤病在全球范围内高度流行，其治疗涉及从局部外用药物到生物制剂的广泛药物谱系。预期寿命的延长和慢性合并症的增加提高了这类患者的手术需求，从而要求对伤口愈合、止血和感染风险进行细致的围手术期管理，尤其是对正在接受免疫抑制或生物制剂治疗的患者。然而，现有文献较为分散，且多从皮肤病学、风湿病学和骨科学来源外推而来。本叙述性综述旨在提供一个以麻醉为重点、基于证据、按药物类别组织的框架，用于成人接受非皮肤科手术时皮肤科药物的围手术期管理。本文对局部外用药物、系统性维A酸类、传统免疫抑制剂、系统性糖皮质激素、生物制剂、小分子药物以及抗菌/抗疟药物进行了综述，涵盖其适应证、药代动力学、当前指南推荐意见以及临床相关的药物-麻醉相互作用。总体而言，大多数皮肤科药物，包括局部外用药物、传统免疫抑制剂和口服维A酸类，均可在围手术期安全继续使用。然而，生物制剂需要根据半衰期确定用药时机，Janus激酶抑制剂应在高感染风险手术前至少停药三天，长期使用系统性糖皮质激素的患者需要采用个体化的应激剂量方案。特定相互作用（异维A酸-琥珀胆碱、氨苯砜-丙胺卡因、环孢素-CYP3A4底物以及羟氯喹-QT延长药物）需要针对性关注。由于证据基础异质性较大且多为观察性研究，这些推荐意见为方向性而非确定性意见，尚需由麻醉科医师主导的前瞻性多中心研究加以验证。

Abstract

Dermatologic diseases are highly prevalent worldwide and are managed with a broad pharmacologic spectrum ranging from topical agents to biologic therapies. Increasing life expectancy and chronic comorbidities have raised the surgical needs of these patients, creating a demand for careful perioperative management of wound healing, hemostasis, and infection risk, particularly in those receiving immunosuppressive or biologic agents. The existing literature, however, is scattered and largely extrapolated from dermatology, rheumatology, and orthopedic sources. This narrative review aims to provide an anesthesia-focused, evidence-based, drug-class-organized framework for the perioperative management of dermatologic medications in adults undergoing non-dermatologic surgery. Topical agents, systemic retinoids, conventional immunosuppressants, systemic corticosteroids, biologic agents, small molecules, and antimicrobial/antimalarial drugs are reviewed with respect to indications, pharmacokinetics, current guideline recommendations, and clinically relevant drug-anesthesia interactions. In general, most dermatologic medications, including topical agents, conventional immunosuppressants, and oral retinoids, can be safely continued perioperatively. However, biologic agents warrant half-life-based timing, Janus kinase inhibitors should be withheld at least three days before high-infection-risk surgery, and patients on chronic systemic corticosteroids require an individualized stress-dose approach. Specific interactions (isotretinoin-succinylcholine, dapsone-prilocaine, cyclosporine-CYP3A4 substrates, and hydroxychloroquine-QT-prolonging agents) require targeted attention. Because the evidence base is heterogeneous and largely observational, the recommendations are directional rather than definitive, and anesthesiologist-led prospective multicenter studies are needed.

如何引用