影响肾上腺嗜铬细胞瘤术中血流动力学稳定因素分析

Analysis of Factors Affecting Intraoperative Hemodynamic Stability of Adrenal Pheochromocytoma

目的分析肾上腺嗜铬细胞瘤患者术中血流动力学不稳定的危险因素,提高围手术期安全性。方法收集2014年6月至2019年3月在我院行手术治疗的46例肾上腺嗜铬细胞瘤患者的临床资料,并将46例患者分为2组:血流动力学稳定组和血流动力学不稳定组。比较分析患者年龄、美国麻醉医师协会(ASA)分级、肿瘤长径、手术方式、术前α受体阻滞剂应用、儿茶酚胺检测、手术时间和失血量等因素与术中血压波动的关系。结果术中血流动力学稳定组和术中血流动力学不稳定组术前ASA分级比较差异有统计学意义(P<0.05),而2组患者的年龄、肿瘤长径、手术方式、术前服用α受体阻滞剂、术前儿茶酚胺检测结果、手术时间和失血量等指标比较差异均无统计学意义(P均>0.05)。多因素logistic回归分析结果显示,患者术前ASA高危分级和未服用α受体阻滞剂是术中血流动力学不稳定的独立危险因素(OR=4.883,95%CI=1.356~17.123,P=0.027;OR=4.554,95%CI=1.238~16.885,P=0.034)。结论肾上腺嗜铬细胞瘤患者术前ASA高危分级和未服用α受体阻滞剂是术中血流动力学不稳定的独立危险因素。应严格掌握手术适应证,对可疑肾上腺嗜铬细胞瘤患者,建议术前服用α受体阻滞剂扩容治疗。

Objective To evaluate the risk factors of hemodynamic instability in patients with adrenal pheochromocytoma,and to improve the perioperative safety.Methods The clinical data of 46 patients with adrenal pheochromocytoma treated surgically in our hospital from June 2014 to March 2019 were analyzed.The 46 patients were divided into two groups.The relationship between age,American Society of Anesthesiologists(ASA)classification,tumor diameter,operation mode,preoperative application of alpha blockers,catecholamine test,operative time and blood loss with intraoperative blood pressure fluctuation were analyzed.Results Univariate analysis showed that there was significant difference in the ASA classification between the hemodynamic stability group and the hemodynamic instability group(P<0.05).There was no significant difference in the age,tumor diameter,operation mode,preoperative alpha blockers,preoperative catecholamine test,operation time and blood loss(P>0.05).Multivariate analysis found that ASA high-risk classification and non-alpha blockers were independent risk factors for hemodynamic instability(OR=4.883,95% CI=1.356~17.123,P=0.027;OR=4.554,95% CI=1.238-16.885,P=0.034).Conclusion Preoperative ASA high-risk classification and non-alpha blockers are independent risk factors in patients with adrenal pheochromocytoma for intraoperative hemodynamic instability.It is recommended that patients with suspected adrenal pheochromocytoma should be treated with alpha blocker and dilatation before operation,and operative indications should be strictly controlled.