嗜铬细胞瘤合并儿茶酚胺心肌病的围术期麻醉管理

Perioperative Anesthetic Management for the Excision of Phaeochromocytoma Complicated with Catecholamine Cardiomyopathy

目的总结嗜铬细胞瘤合并儿茶酚胺心肌病患者的围术期麻醉管理经验。方法描述3例嗜铬细胞瘤合并儿茶酚胺心肌病患者的临床特点及围术期麻醉管理,并结合文献报道进行讨论。结果3例嗜铬细胞瘤合并儿茶酚胺心肌病患者的临床表现为左心室肥厚、充血性心力衰竭以及急性心肌梗死发作。在全麻下切除嗜铬细胞瘤后,均表现为持续性低血压;术后为维持血流动力学指标稳定,均使用了大剂量的儿茶酚胺类药物。3例患者均痊愈出院。结论心功能不全是导致切除嗜铬细胞瘤后持续性低血压的重要因素。术前仔细评估心脏功能对于术中麻醉管理具有重要的意义。

Objective To summarize experience of perioperative anesthetic management for patients undergone excision of pheochromocytoma and complicated with catecholamine cardiomyopathy.Methods Perioperative anesthetic management for surgical treatment of three cases of pheochromocytoma complicated with catecholamine cardiomyopathy was described and discussed according to literature reports.Results The catecholamine cardiomyopathy of the three cases presented with left ventricular hypertrophy,congestive cardiac failure and acute myocardial infarction.After removal of the pheochromocytoma under general anesthesia,a prolonged hypotension occurred in all of the three cases.In order to maintain stable hemodynamics,large dose of catecholamine was required after surgery.All of the three patients were survived and discharged.Conclusions It is suggested that myocardial dysfunction may be another important factor for the prolonged hypotension after removal of the tumor.Meticulous preoperative assessment of heart function is of primary importance for the management of anaesthesia during surgical procedures.