摘要
目的探讨血压正常的偶发嗜铬细胞瘤患者围手术期血压及心率特点,为制定围手术期方案提供依据。方法回顾总结2011年1月至2016年12月在解放军总医院就诊的肾上腺偶发瘤中,经病理确诊为单侧嗜铬细胞瘤的104例患者资料。根据是否有高血压分为血压正常的偶发嗜铬细胞瘤(NIP)组(50例)和有高血压的偶发嗜铬细胞瘤(HIP)组(54例)。分析2组间一般临床资料及围手术期血流动力学特点。结果(1)NIP组年龄、尿去甲肾上腺素、酚苄明用药剂量及用药时间低于HIP组(均P〈0.05)。(2)NIP组麻醉前血压、术中最高血压及术中总入液量更低(均P〈0.05),2组间术中血压波动范围、心率波动范围、血压升高程度、最低平均动脉压及血管活性药应用差异无统计学意义。(3)2组间收缩压升高程度[高于30%麻醉前收缩压、200 mmHg(1 mmHg=0.133 kPa)、180 mmHg、160 mmHg]、心动过速、心动过缓、术中及术后低血压的例数或次数的比较差异无统计学意义。(4)进一步以年龄50岁、酚苄明剂量40 mg/d、肿瘤直径50 mm及麻醉前血压130/80 mmHg对患者进行分层,2组间术中血压及心率的比较差异无统计学意义。(5)围手术期是否发生低血压与酚苄明的剂量及用药时间无关。NIP组围手术期低血压的发生也与酚苄明及术中血管活性药的应用无关。结论NIP患者围手术期血压及心率变化与HIP患者相似,应给予充分的围手术期准备,避免围手术期血流动力学剧烈波动。
ObjectiveTo investigate the characteristics of peroperative blood pressure and heart rate in patients with normotensive incidental pheochromocytomas in order to provide the basis for peroperative treatment.
MethodsThis retrospective study collected the data of 104 patients with a pathological diagnosis of unilateral pheochromocytoma at PLA General Hospital during January 2011 to December 2016. They were divided into normotensive incidental pheochromocytomas(NIP)group(n=50)if the patients were normotensive and HIP group(n=54)if the patients were with hypertension. The clinical features, imaging features and peroperative hemodynamics were analyzed.
Results(1)The age, urinary norepinephrine, daily dosage and duration of phenoxybenzamine in NIP group were less than those of HIP group(all P〈0.05). (2)Preinduction blood pressure, maximum blood pressure, and total fluid intake in NIP group were lower than those in HIP group(all P〈0.05). The blood pressure range, heart rate range, increased blood pressure, minimum mean arterial pressure, vasoactive medication were without statistical significance between these two groups.(3)The times and rate of intraoperative systolic blood pressure more than 30% baseline, 200 mmHg(1 mmHg=0.133 kPa), 180 mmHg, 160 mmHg, intraoperative tachycardia, bradycardia, intraoperative hypotension and postoperative hypotension were without statistical significance between these two groups.(4)Stratified analysis of age(50 years), phenoxybenzamine(40 mg/d), tumor diameter(50 mm)and preinduction blood pressure(130/80 mmHg)showed that intraoperative blood pressure and heart rate were without statistical significance between these two groups.(5)There was no correlation between phenoxybenzamine(daily dosage or duration)and peroperative hypotension. Applying phenoxybenzamine or vasoactive medication was not correlated with peroperative hypotension in NIP group.
ConclusionThe peroperative blood pressure and heart rate of patients with NIP are similar to those of patients with HIP. Adequate peroperative treatment should be applied to NIP to avoid hemodynamic instability.
作者
刘颖姝
李乐乐
窦京涛
汪保安
杜锦
杨国庆
臧丽
王先令
巴建明
吕朝晖
高政南
母义明
Liu Yingshu;Li Lele;Dou Jingtao;Wang Baoan;Du Jin;Yang Guoqing;Zang Li;Wang Xianling;Ba Jianming;Lyu Zhaohui;C ao Zhengnan;Mu Yiming(Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China)
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2018年第6期466-471,共6页
Chinese Journal of Endocrinology and Metabolism
关键词
嗜铬细胞瘤
高血压
围手术期
血压
心率
Pheochromocytoma
Hypertension
Peroperation
Blood pressure
Heart rate