嗜铬细胞瘤临床功能分级与术前准备标准的探讨

The discussion of standards for clinical functional gradation and preoperative preparation of pheochromocytoma

目的 探讨嗜铬细胞瘤临床功能分级与术前准备的标准。方法 我院 1990年 1月至2 0 0 3年 11月手术治疗 172例嗜铬细胞瘤病例 ,根据术前临床症状、2 4h尿儿茶酚胺中去甲肾上腺素、肾上腺素和多巴胺水平将其临床功能分为 4级。功能 0级 2 2例 ,未给予扩容准备 ;功能 1级 17例 ,随机双盲法抽取 10例口服酚苄明 5～ 10mg/d持续 1周 ,其余 7例为对照 ,比较两者围手术期血压的变化 ;功能 2级 12 0例 ,术前口服酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,应用血流动力学指标及微循环图像判断扩容效果 ;功能 3级 13例 ,应用酚苄明及相应的心肺脑复苏措施。全部病例均在全麻下行肿瘤探查切除术。结果 功能 0级者围手术期血压平稳。功能 1级者血压均有波动 (<80mmHg) ,酚苄明治疗者波动幅度 <2 0mmHg ,对照者 >4 0mmHg(χ2 值为 13 12 ,P <0 0 1)。功能 2级和 3级者血压波动幅度 >80mmHg ,术后 2 4h内血流动力学恢复正常 ,无并发症。结论 根据嗜铬细胞瘤功能分级可采取不同的术前准备 ,功能 0级无需扩容 ,功能 1级可口服酚苄明 5～ 10mg/d持续 1周 ,功能 2级必须应用酚苄明 30～ 2 4 0mg/d充分扩容 4周 ,功能 3级必须心肺脑复苏加充分扩容 ,心肺脑功能基本正常后方可手术。

Objective To discuss the standards for clinical functional gradation and preoperative preparation of pheochromocytoma Methods According to the preoperative clinical manifestations and 24 hours urine catecholamine, 172 cases of pheochromocytomas were divided into 4 grades Functionary grade 0 including 22 patients was given no volume expansion Functionary grade 1 consisted of 17 cases, 10 of which were given phenoxybenzamine orally 5-10 mg/d for 1 week(therapeutic group), the rest were control group; the results were analyzed by the χ 2 test Functionary grade 2 including 120 patients had phenoxybenzamine orally 30-240 mg/d for 4 weeks, hemodynamics and microcirculation image were standards for evaluating volume expansion Functionary grade 3 consisted of 13 patients including 1 with acute heart failure, 2 and 10 patients with past history of cerebral hemorrhage and hypertensive crisis respectively, they were treated with enough phenoxybenzamine and other emergent measures Results The perioperative blood pressure of functionary grade 0 had no fluctuation The blood pressure of therapeutic group of functionary grade 1 had small range fluctuation( <20 mm Hg),that of the control group was large (> mm Hg),χ 2=13 12, P <0 01 The hemodynamics of functionary grade 2 and grade 3 recovered within 24 hours postoperatively and no complications occurred Conclusions According to the function of pheochromocytoma, it is safe and efficient to use different preoperative preparations Hemodynamics and microcirculation image are golden standards for evaluating preoperative preparations