预先应用酚妥拉明对嗜铬细胞瘤术中血流动力学的影响

Continuous infusion of phentolamine during the surgry for pheochromocytoma: evaluation of the haemodynamic condition

目的评价嗜铬细胞瘤手术中预先给予酚妥拉明对维持血流动力学稳定的效果。方法选择术后病理诊断嗜铬细胞瘤的患者19例,ASAⅡ~Ⅲ级。根据应用酚妥拉明方法的不同分成Ⅰ、Ⅱ两组,其中Ⅰ组9例,Ⅱ组10例。根据血压情况,Ⅰ组泵注0.08%酚妥拉明;Ⅱ组在分离瘤体前2min给予酚妥拉明10mg。术中根据血压和心率变化给予乌拉地尔或艾司洛尔。记录麻醉前（T0）、探查肿瘤前（T1）、探查肿瘤时（T2）、肿瘤血管阻断时（T3）和术毕（T4）5个时点的平均动脉压（MAP）、心率（HR）和中心静脉压（CVP）以及血管活性药物使用情况。结果两组患者麻醉前MAP（T0）无统计学差别（P〉0.05）;术中肿瘤探查前（T1）均有不同程度的升高;肿瘤探查时（T2）,Ⅰ组的MAP明显升高（P〈0.05）,且高于Ⅱ组（P〈0.05）;肿瘤血管阻断后（T3）和术毕时（T4）,两组的MAP均明显降低（P〈0.05）,但组间比较无统计学差异（P〉0.05）。两组患者的HR均于插管后升高（P〈0.05）,肿瘤探查时达峰值（P〈0.01）,至手术结束时仍高于麻醉前水平（P〈0.05）,各时点组间比较无统计学差异（P〉0.05）。两组患者的CVP均无明显变化（P〉0.05）,组间比较也无统计学差异（P〉0.05）。Ⅰ组酚妥拉明和乌拉地尔的用量明显多于Ⅱ组（P〈0.01）;两组间艾司洛尔和去甲肾上腺素的用量无明显差别（P〉0.05）。结论在充分术前准备的情况下,针对嗜铬细胞瘤术中分离瘤体时易引起血流动力学波动的手术步骤,预先给予酚妥拉明可有效维持患者的血流动力学稳定,并可减少其他降压药的使用。

Objective To evaluate the hamodynamic conditon when continuously use phentolamine during pheochromocytoma surgery. Methods Nineteen patients who underwent laparoscopic adrenalectomy and finally confirmed as pheochromocytoma by pathological examination, ASA grade Ⅱ-Ⅲ, were divided into two groups. Nine cases were chosen into group Ⅰ, the other ten cases were enrolled into group Ⅱ. According to the level of blood pressure （BP） , 0.08% phentolamine was continuous infusion in group Ⅰ, while 10 mg of phentolamine was used at 2 minutes before manipulation of the tumor. Urapidil or esmolol was sometimes used according to the blood pressure and heart rates. The mean arterial pressure （MAP）, heart rate （HR） and central venous pressure （CVP） were recorded at the following five period： prior to anesthesia （T0）, before manipulation of the tumor （T1）, during dissection of the tumor （T2）, after ligation of tumor’s venous supply （T3） and when the operation was completed （T4）. The dosage of vasoactive agents were also recorded. Results MAP was not statistically different at T0 and increased at T1 in both groups. At T2 period, however, MAP raised significantly in group Ⅰ（P〈0.05）, and was higher than that in group Ⅱ（P〈0.05）. MAP decreased significantly at T3 and at T4 periods, but there were no statistical differences between the two groups （P〈0.05）. HR increased after tracheal intubation, and gradually reached peak value at T3, then decreased at T4, but it is still higher than that at T0, differences between the two groups were not statistically significant （P〈0.05）. The changes of CVP were all in the normal range, there were no obvious difference between the groups. The dosage of phentolamine in group Ⅰwere more than that in group Ⅱ （P〈0.01）, and so as the urapidil （P〈0.01）, while there were no differences about the dosage of both esmolol and noradrenaline （P〉0.05）. Conclusions Use of phentolamine prior to the surgery can sustain the hemodynamic stability and decrease the use of other hypotensive drugs.