嗜铬细胞瘤围术期单独应用尼卡地平的价值

Exclusive use of nicardipine in peri-operative management of pheochrocytoma.

目的 探讨钙通道阻滞剂尼卡地平在嗜铬细胞瘤摘除术前、中的应用价值。方法1999-10/2002-7收治嗜铬细胞瘤患者10例。术前口服尼卡地平(40～80mg,2次)10～14d作为手术前控制血压的药物,术中控制收缩压在16.0-21.3kPa之间,调节尼卡地平静脉注射浓度[(1-μg/kg.min)],在结扎肿瘤的引流静脉前停药。结果2例在术中分离肿瘤时出现高血压危象(收缩压>26.7kPa),但被尼卡地平有效地控制住。另4例术中血压波动不大。所有患者术后均无须使用升压药。结论 钙离子通道阻滞剂尼卡地平是安全、有效、副作用小的药物,可以替代常规的α-受体阻滞剂作为嗜铬细胞瘤手术前、术中控制高血压。

AIM To investigate the value of exclusive use of calcium channel blockers, nicardipine, in pre-and intra-op-erative management of pheochrocytoma. METHODS Ten patients with pheochrocytoma were treated between Oct. 1999 and July 2002. Nicardipine(80-160 mg/d) was used orally in the pre-operative period for 10-14d and nicardipine infusion [(1-4 μg/(kg.min)] was adjusted to maintain systolic arterial pressure between 16.0 and 21.3kPa and stopped before ligation of the tumor venous drainage. RESULTS Hypertentive crisis (systolic arterial pressure > 26.7kPa) was occurred in 2 patients during tumor manipulation and was effectively controlled by nicardipine. A minimum changes of mean arterial pressure was observed in 4 patients. Anti-hypotensive medicine was not used in all patients postoperatively. CONCLUSION Calcium channel blocker, nicardipine, is just as effective, safe and little side effects medicine and might be used as a substitute to routine ot-adrenergic blocked in the pre-and intraoperative management of pheochrocytoma.