后腹腔镜下肾上腺嗜铬细胞瘤切除术中血压波动的影响因素分析

Analysis of the influencing factors of blood pressure fluctuation during retroperitoneoscopic adrenalectomy for pheochromocytoma

目的分析后腹腔镜下肾上腺嗜铬细胞瘤切除术中血压波动的影响因素。方法94例行后腹腔镜下肾上腺嗜铬细胞瘤切除术且术后病理确诊为嗜铬细胞瘤的患者为研究对象,按患者术中有无血压剧烈变化分为血流动力学稳定组(51例)和血流动力学波动组(43例)。分析患者的人口学特征,肿瘤学特征,术前儿茶酚胺检查,围术期扩容准备,术前合并症有无,美国麻醉医师协会(ASA)分级,手术麻醉等相关因素与术中血压波动的关系。结果单因素分析显示,两组年龄、ASA分级、24 h尿香草扁桃酸(VMA)、术前最高收缩压比较,差异具有统计学意义(P<0.05);两组性别、体质量指数(BMI)、既往高血压病史、嗜铬细胞瘤典型症状、隐匿性嗜铬细胞瘤、α受体阻滞剂应用、红细胞比积、香草扁桃酸、高香草酸、去甲变肾上腺素、肾上腺素、去甲肾上腺素、多巴胺、变肾上腺素、术前扩容时间、术前血压准备、术前扩容是否充分、肿瘤最大直径、手术时间、术中出血量比较,差异无统计学意义(P>0.05)。将两组间比较有统计学意义的因素纳入二元Logistic回归分析,结果显示,24 h尿VMA是后腹腔镜下肾上腺嗜铬细胞瘤切除术中血压波动的独立危险因素[OR=1.025,95%CI=(1.001,1.049),P=0.041<0.05]。按多因素二元Logistic回归方程计算的概率预测值绘制成受试者工作特征曲线(ROC曲线),经检验,该方程的总体预测率为63.8%,计算曲线下面积为0.725[95%CI=(0.623,0.828)]。结论24 h尿VMA是后腹腔镜下肾上腺嗜铬细胞瘤切除术中血压波动的独立危险因素,临床医师可以通过完善24 h尿VMA检查初步评估患者术中血压波动的可能。

Objective To analyze the influencing factors of blood pressure fluctuation during retroperitoneoscopic adrenalectomy for pheochromocytoma.Methods 94 patients who underwent retroperitoneoscopic adrenalectomy for pheochromocytoma with postoperative pathological diagnosis of pheochromocytoma were selected as the research subjects and they were divided into hemodynamically stable group(51 cases)and hemodynamically fluctuating group(43 cases)according to whether there were severe changes in blood pressure during surgery.Patients'demographic characteristics,oncologic characteristics,preoperative catecholamine screening,perioperative volume expansion preparation,presence of preoperative comorbidities,American Society of Anesthesiologists(ASA)classification,surgical anesthesia,and other relevant factors were analyzed in relation to intraoperative blood pressure fluctuations.Results Univariate analysis showed that there were significant differences in age,ASA classification,24-h urinary vanillylmandelic acid(VMA),and preoperative highest systolic blood pressure between the two groups(P<0.05).The gender,body mass index(BMI),previous history of hypertension,typical symptoms of pheochromocytoma,occult pheochromocytoma,α-blocker application,hematocrit,vanilmandelic acid,homovanillic acid,normetanephrine,epinephrine,norepinephrine,dopamine,metanephrine,preoperative volume expansion time,preoperative blood pressure preparation,whether preoperative volume expansion was sufficient,maximum tumor diameter,operation time,intraoperative blood loss were compared between the two groups,and the differences were not statistically significant(P>0.05).Factors that were statistically significant for comparison between the two groups were included in a binary Logistic regression analysis,which showed that 24-h urinary VMA was an independent risk factor for blood pressure fluctuations during retroperitoneoscopic adrenalectomy for pheochromocytoma[OR=1.025;95%CI=(1.001,1.049);P=0.041<0.05].The probability prediction value calculated by the multivariate binary Logistic regression equation was drawn as the receiver operating characteristic curve(ROC curve),which were tested to have an overall predictive rate of 63.8%and a calculated area under the curve of 0.725[95%Cl=(0.623,0.828)].Conclusion The 24-h urine VMA is an independent risk factor for blood pressure fluctuations during retroperitoneoscopic adrenalectomy for pheochromocytoma,and clinicians can initially assess the possibility of intraoperative blood pressure fluctuations in patients by perfecting the 24-h urinary VMA test.