嗜铬细胞瘤患者经腹腔镜肾上腺切除术后血流动力学不稳定的影响因素分析

Analysis of influencing factors of hemodynamic instability in patients with pheochromocytoma after laparoscopic adrenalectomy

目的 探讨嗜铬细胞瘤患者经腹腔镜肾上腺切除术后血流动力学不稳定的影响因素。方法 收集2015年1月至2022年6月在本院泌尿外科行腹腔镜肾上腺切除术的嗜铬细胞瘤患者78例,按术后是否发生血流动力学不稳定分成不稳定组(n=13)和稳定组(n=65)。比较两组性别、年龄、体质量指数(body mass index,BMI)、高血压史、术前血细胞比容(hematocrit HCT)、术前血红蛋白水平、肿瘤位置、肿瘤直径、手术时间、麻醉时间、术中出血量、术中血流动力学是否稳定和术后乳酸浓度。比较两组术后拔管时间、术后入住重症监护室(intensive care unit,ICU)比例、术后入住ICU时间、术后需继续机械通气比例、术后继续机械通气时间、术后并发症和住院时间等情况。对术后血流动力学不稳定组进行单因素和多因素logistic回归分析。结果 共13例出现术后血流动力学不稳定,发生率为16.7%。多因素logistic回归分析显示,双侧肿瘤、术后乳酸浓度和麻醉时间是术后血流动力学不稳定的独立危险因素(均P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析显示,嗜铬细胞瘤患者经腹腔镜肾上腺切除术后乳酸浓度对术后血流动力学不稳定的预测界值为4.2 mmol/L,敏感度为84.2%,特异度为78.3%。结论 双侧肿瘤、术后乳酸浓度和麻醉时间是嗜铬细胞瘤患者经腹腔镜肾上腺切除术后血流动力学不稳定的独立危险因素。术后乳酸浓度对术后血流动力学不稳定具有一定的诊断价值。

Objective To investigate the influencing factors of hemodynamic instability in patients with pheochromocytoma after lap-aroscopic adrenalectomy.Methods Seventy-eight patients with pheochromocytoma who underwent laparoscopic adrenalectomy in our urology department from January 2015 to June 2022 were collected.Patients with and without postoperative hemodynamic instability were divided into the unstable(n=13)and stable(n=65)groups,respectively.The differences in gender,age,body mass index(BMI),history of hypertension,preoperative hematocrit(HCT),preoperative hemoglobin level,tumor location,tumor diameter,operation duration,anesthesia duration,intraoperative bleeding,whether intraoperative hemodynamics was stable,and postoperative lactate concentration were analyzed between the two groups.The comparison of postoperative extubation time,the number of postoperative intensive care unit(ICU)admissions,the duration of postoperative ICU stay,the number of postoperative cases needing continued mechanical ventilation,the duration of post-operative continued mechanical ventilation,postoperative complications,and hospitalization time between the two groups,and univariate and multivariate logistic regression analyses on the unstable group were performed.Results A total of 13 cases showed postoperative he-modynamic instability,with an incidence rate of 16.7%.Multivariate logistic regression analysis showed that bilateral tumors,postoperative lactate concentration,and anesthesia duration were the independent risk factors for postoperative hemodynamic instability(all P<0.05).The receiver operating characteristic(ROC)curve analysis showed that for the prediction of postoperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma,the critical point of postoperative lactate concentration was 4.2 mmol/L,with a sensitivity of 84.2%and a specificity of 78.3%.Conclusions Bilateral tumors,postoperative lactate concentration,and the duration of anesthesia are the independent risk factors for postoperative hemodynamic instability in patients undergoing laparoscopic adrenalectomy for pheochromocytoma.Postoperative lactate concentration has a diagnostic value for postoperative hemodynamic instability.