嗜铬细胞瘤手术的麻醉管理

Anesthetic management for surgical treatment of pheochromocytoma

目的探讨嗜铬细胞瘤切除术的麻醉管理方法。方法回顾性分析2007年1月-2008年9月上海交通大学医学院附属瑞金医院76例嗜铬细胞瘤患者的围术期临床表现、治疗方法、麻醉手术效果,探讨此手术的术前准备、麻醉诱导与维持、术中监测、液体管理和血管活性药物使用等方面的经验。结果所有患者均安全度过围术期,无手术麻醉并发症。通过实施麻醉诱导期急性高容量填充策略,术中循环维持稳定,红细胞压积由诱导后即刻的0.352±0.093降至手术探查前的0.262±0.042,绝大部分患者均在术后1h内停用血管活性药物并拔除气管导管,送返病房。结论α受体阻滞剂的使用和血容量的适量扩充是控制嗜铬细胞瘤术后转归的重要环节。

Objective To investigate the anesthetic management for surgical treatment of pheochromocytoma. Methods The clinical features, treatment approaches, anesthetic management and outcomes of surgery were retrospectively analyzed in 76 pheochromocytoma patients who were treated during Jan. 2007 to Sept. 2008 in our hospital. The experience on preoperative preparation, anesthetic induction and maintenance, the intraoperation monitoring and fluid management, and the use of vasoactive agents were summarized. Results All the patients had an uneventful perioperative period, with no anesthetic complication. Acute hypervolemic fluid infusion （AHFI） during anesthesia induction maintained stable circulation; and the Hct dropped from 0. 353± 0. 093 immediately after induction to 0. 262±0. 042 before resection of the tumor. Most patients stopped the use of vasopressors and were extubated within 1 hour after the surgery, and they were sent back to the ward. Conclusion It is concluded that alpha-adrenergic receptor blockers and proper volume expansion are keys for good outcomes of phaeochromocytoma patients after resection. （Shanghai Med J, 2009,32：117-120）