颈动脉体瘤切除术中患者持续使用升压药物的危险因素分析

Risk Factors for Patients Using Intraoperative Vasopressor Infusions During Carotid Body Tumor Excision

目的分析颈动脉体瘤切除术中患者持续使用升压药物的危险因素,并同时分析患者术中心率、血压波动情况及其对血管活性药物的需求。方法本研究为回顾性研究。纳入2013年5月1日至2017年7月31日于北京协和医院接受颈动脉体瘤切除手术的患者,对术中需持续使用升压药物的患者进行单因素和多因素分析,同时分析Shamblin分型与术中血压心率波动、血管活性药物使用的关系。结果共纳入108例患者,共116侧颈动脉体瘤切除手术。单因素分析中,肿瘤最长径>4 cm、术中颈内动脉损伤、颈内动脉重建、恶性病理、高Shamblin分型(Ⅱ型或Ⅲ型)、失血量≥400 ml以及手术时长>4 h的患者术中持续使用升压药物的需求增加。Logistic多因素分析得出ShamblinⅢ型(OR=2.286,95%CI=1.324~14.926,P=0.016)、手术时长>4 h(OR=3.874,95%CI=1.020~14.623,P=0.046)为颈动脉体瘤切除术中患者需持续使用升压药物的危险因素。此外,ShamblinⅢ型与术中心率异常升高、术中使用升压药物显著相关。结论ShamblinⅢ型、手术时长>4 h是患者术中持续使用升压药物的危险因素。ShamblinⅢ型的患者术中心率异常升高、术中使用升压药物的需求增加。

Objective To investigate the risk factors for patients using intraoperative vasopressor infusions during carotid body tumor(CBT)excision.Patients’mean arterial pressure(MAP)and heart rate(HR)fluctuations as well as their requirements for vasoactive agents during surgery were assessed.Methods The patients receiving CBT excision in Peking Union Medical College Hospital from May 1,2013 to July 31,2017 were included for a retrospective cohort study.The potential factors of intraoperative requirement for vasopressor infusions were investigated using univariate analysis and Logistic multivariate analysis.Furthermore,the relationships of Shamblin types of CBT with intraoperative MAP/HR fluctuations and requirements for vasoactive agents were analyzed.Results A total of 108 patients with 116 CBTs were included.Univariate analysis revealed that maximum tumor diameter>4 cm,intraoperative internal carotid artery injury,internal carotid artery reconstruction,malignant pathology,advanced Shamblin types(typeⅡandⅢ),estimated blood loss≥400 ml,and operation duration>4 hours were associated with intraoperative requirements for vasopressor infusions.Logistic analysis showed that Shamblin typeⅢ(OR=2.286,95%CI=1.324-14.926,P=0.016)and operation duration>4 hours(OR=3.874,95%CI=1.020-14.623,P=0.046)were risk factors for intraoperative requirements for vasopressor infusions during CBT surgery.In addition,Shamblin typeⅢwas associated with intraoperative abnormal HR elevation and requirements for vasopressors.Conclusions Shamblin typeⅢand operation duration>4 hours are risk factors for intraoperative requirements of patients for using vasopressor infusions during CBT surgery.Shamblin typeⅢis associated with intraoperative abnormal HR elevation and requirements for vasopressors.