嗜铬细胞瘤围手术期血压变化的影响因素分析

The analysis of influencing factors of perioperative blood pressure fluctuation of pheochromocytoma

目的分析引起嗜铬细胞瘤围手术期血压波动的影响因素，探讨改善其血流动力学的措施。方法对2000—2010年收治的经手术治疗的嗜铬细胞瘤患者的临床资料进行回顾性研究。采用Pearson相关分析和多元Logistic回归等统计学方法对影响围手术期血压波动的因素进行分析。结果Pearson相关分析显示术中收缩压的最大波动值（ASBP）的影响因素包括术前最高收缩压（r=0．196，P=0．013）、术前24h尿肾上腺素含量（r=0．207，P=0．008）及术中失血量（r=0．253，P=0．003）。多元Logistic回归分析显示影响术后顽固性低血压的因素包括24h尿去甲肾上腺素（OR=1．273，P=0．002）、术前准备时间（OR=0．921，P=0．034）；术后高血压的危险因素有肿瘤残留（OR=16．920，P=0．001）、术前红细胞压积变化（OR=1．467，P=0．018）。结论尽管经过充分的术前准备，嗜铬细胞瘤患者围手术期仍可发生较大的血压波动。嗜铬细胞瘤围手术期的血压波动受到多种因素影响，针对这些影响因素采取措施，可减少血压的波动，从而减少手术风险。

Objective To analyze the influencing factors of the blood pressure fluctuation during the perioperative period of pheochromocytoma, and discuss the ways to improve the hemodynamics. Methods The clinical data of patients with pheochromocytoma who had received operation from 2000 to 2010 were studied retrospectively. The influencing factors of perioperative blood pressure fluctuation were analyzed by statistical methods including Pearson correlation analysis and Logistic regression. Results According to Pearson correlation analysis, the influencing factors of the highest fluctuation value of the systolic blood pressure （ A SBP） during the operation included the preoperative highest systolic blood pressure （r = 0.196, P = 0.013 ）, the content of preoperative 24-hour urine epinephrine （r = 0.207, P = 0.008） and the lost blood volume during the operation （r = 0.253 ,P= 0.003）. Logistic regression analysis showed that the postoperative persisting hypotension was influenced by the content of preoperative 24-hour urine norepinephrine （OR = 1.273,P =0.002） and preoperative preparation duration （OR =0.921,P =0.034）;the risk factors of postoperative hypertension were residual tumor （OR = 16.920,P = 0.001 ） and the preoperative hematocrit change （OR = 1.467,P=0.018）. Conclusions In spite of the adequate preoperative preparation,great changes of blood pressure would still occur during the perioperative period of pheochromocytoma,and it is influenced by many factors. Corresponding measures aiming to these factors should be taken to decrease the perioperative blood pressure fluctuation and surgical risks.