嗜铬细胞瘤术前准备的临床体会(附286例报告)

Clinical experience with preoperative preparation for pheochromocytoma (report of 286 cases)

目的 探讨嗜铬细胞瘤术前准备的临床体会。 方法 收集 1980～ 2 0 0 2年收治 2 86例嗜铬细胞瘤患者术前准备资料。术前使用酚苄明 2 0 7例 ,使用压宁定 78例 ,1例未用α 肾上腺素能阻滞剂做术前准备 ,急诊手术。用药时间 2～ 9周 ,平均 6周。 2 8%的患者术前加服 β 受体阻滞剂控制心率。 结果 2 5 4例患者血压稳定在 16 .0 / 10 .7kPa(12 0 / 80mmHg)左右 ,无阵发性血压升高 ,心悸 ,多汗等现象 ,体重呈增加趋势 ,心率 80～ 85次 /min ,外周微循环明显改善。肿瘤大小 (直径 3～ 12cm ,平均 5 .2cm)与功能和用药时间长短无明显关系。术前 2周发生高血压危象 32例 ,96 %的患者麻醉诱导和术中挤压肿瘤时血压仍发生波动 ,最高可达 38/ 2 4kPa(2 85 / 180mmHg) ,但较易控制 ,术后血压平稳。 结论 嗜铬细胞瘤术前充分的准备是保证麻醉、术中及术后血压平稳控制、减少心血管并发症和死亡率的关键。

Objective To investigate the preoperative preparation for pheochromocytoma. Methods The data of 286 cases of pheochromocytoma, who were treated in our hospital from 1980 to 2002,were collected and reviewed on the preoperative preparation.Phenoxybenzamine was given to 207 cases and urapidil to 78 during preoperative period, lasting for 2～9 weeks with a mean of 6 weeks.The remaining 1 underwent emergent surgery without use of α-adrenergic blockers.In 28% of the cases,β-adrenergic blocker was given for control of heart rate. Results In 254 cases,blood pressure remained stable at the level of 120/80 mm Hg (1 mm Hg=0.133 kPa) or so.No paroxysmal hypertension,palpitation and sweating occurred after use of α-blockade.The heart rate remained 80～85 times/min.No arrhythmia occurred.Peri-microcirculation was obviously improved.The tumor size (range,3～12 cm in diameter;mean,5.2 cm) was not related to the function and length of preoperative use of the medications.Hypertensive crisis occurred in 32 cases 2 weeks before operation. In most cases (96%), blood pressure fluctuated (reaching up to 280/180 mm Hg) when they experienced anesthesia induction and tumor crush during operation.However,it was easy to control.Postoperative blood pressure remained stable. Conclusions The full preoperative preparation for patients with pheochromocytoma is essential for the safety and success of anesthesia and operation.