嗜铬细胞瘤及副神经节瘤的术中血压波动影响因素的分析

Preoperative preparation and analysis of influencing factors of perioperative blood pressure fluctuation in patients with pheochromocytoma or paraganglioma

目的提高对嗜铬细胞瘤及副神经节瘤的认识,探讨嗜铬细胞瘤及副神经节瘤围手术期的血压管理及术前准备方法。方法收集本院2002年—2015年经手术治疗并病理证实的61例包括嗜铬细胞瘤及副神经节瘤患者的临床资料进行回顾性研究,运用t检验、卡方检验和Pearson相关分析等统计学方法对临床表现、术前准备方案及术中血压波动的影响因素进行分析。结果术前联合应用钙离子拮抗剂的患者术前3天平均舒张压显著低于单用α受体阻滞剂的患者(P=0.034),但两组术中血压波动情况无明显差别(P=0.755)。Pearson相关分析提示术中血压波动与术前最高收缩压(r=0.329,P=0.010)、肿瘤最大直径(r=0.256,P=0.046)及术前3天平均舒张压(r=0.356,P=0.004)呈正相关。结论α受体阻滞剂具有良好的降压扩容作用,联合钙离子拮抗剂使用能更好地控制术前血压,但术中血压的较大波动仍有可能在充分术前准备的患者中发生,对于术前血压较高者及肿瘤较大者更应警惕术中出现血压波动的可能,预备应对措施,减少手术风险和并发症的发生。

Objective To deepen the understanding of pheochromocytoma andparaganglioma, and to investigate the blood pressure management and preoperative preparationmethods in the perioperative period. Methods Sixty-one cases of clinical data from 2002 to 2015after surgery and pathology including pheochromocytoma and paraganglioma were retrospectivelystudied. Influence factors of clinical manifestations, preoperative and intraoperative bloodpressure fluctuations were analyzed using t-test, chi square test and Pearson correlation analysis,etc.Results The mean 3-day preoperative diastolic blood pressure of patients with combinedapplication of calcium antagonists was significantly lower than that of single alpha blockers(P=0.034), but the blood pressure fluctuations between the two groups have no significantdifference (P=0.755). Pearson correlation analysis showed that the intraoperative blood pressurefluctuation was positively correlated to preoperative maximum systolic blood pressure (r = 0.329,P=0.010), the maximum diameter of tumor (r=0.256,P=0.046) and mean 3-day preoperativediastolic blood pressure (r=0.356,P=0.004). Conclusion Alpha blocker antihypertensives havegood expansion effect. It can achieve the better control of preoperative blood pressure if combinedwith calcium antagonists, but the fluctuation of intraoperative blood pressure may still occur inpatients with sufficient preoperative preparation, especially in patients with higher blood pressureand larger tumor. Thus, more attentions about intraoperative blood pressure fluctuation should begiven to this group of patients so as to reduce the incidence of surgical complications and risks.