Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma
Risk Factors for Hemodynamic Instability during Surgery for Pheochromocytoma
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DOI：
10.1210/jc.2009-1051
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发表时间：
2010-02-01
影响因子：
5.8
通讯作者：
Kazemier, G.
中科院分区：
文献类型：
--
作者：
Bruynzeel, H.;Feelders, R. A.;Kazemier, G.
背景：嗜铬细胞瘤的手术存在血流动力学（HD）不稳定的风险。本研究的目的是确定术中HD不稳定的术前风险因素。此外，与α-肾上腺素能受体（α）拮抗剂酚苄明（PXB）和多沙唑嗪（DOX）的预处理的疗效进行了比较，减少术中HD stability.Methods：七十三例手术在伊拉斯谟医疗中心1995年和2007年之间。研究的参数包括儿茶酚胺类型和浓度、肿瘤直径、α-拮抗剂预处理前后的平均动脉压（MAP（α））、预处理后血压（BP）的体位性下降、α-阻滞剂类型、手术类型和家族性多肿瘤综合征的存在。通过测量MAP低于60 mm Hg和收缩压（SBP）高于160 mm Hg的次数和时间来评估HD不稳定性。结果：发现SBP高于160 mm Hg的时间与血浆去甲肾上腺素水平相关（r = 0.23; P < 0.05）、肿瘤直径（r = 0.36; P < 0.01）、体位性血压下降（r = 0.30; P < 0.05）。血压130/85 mm Hg与SBP> 160 mm Hg的发作次数和时间相关（P < 0.01）。手术类型或α-阻滞和家族性多发性肿瘤综合征的存在与术中HD不稳定无关。DOX组术后MAP低于PXB组（P < 0.05）。结论：肾上腺嗜铬细胞瘤术中HD不稳定的危险因素包括血浆NE浓度高、肿瘤体积大、α受体阻滞后体位性血压下降幅度大、MAP> 100 mmHg（130/85 mmHg）。PXB和DOX预防HD不稳定的疗效相同。（临床内分泌代谢杂志95：678-685，2010）
Background: Surgery on pheochromocytoma carries a risk for hemodynamic (HD) instability. The aim of this study was to identify preoperative risk factors for intraoperative HD instability. In addition, efficacy of pretreatment with the alpha-adrenergic receptor (alpha) antagonists phenoxybenzamine (PXB) and doxazosin (DOX) was compared with respect to reduction of intraoperative HD instability.Methods: Seventy-three patients operated in Erasmus Medical Center between 1995 and 2007 were included. Parameters studied were catecholamine type and concentration, tumor diameter, mean arterial pressure (MAP) before and after (MAP(alpha)) pretreatment with alpha-antagonist, postural fall in blood pressure (BP) after pretreatment, type of alpha-blockade, type of operation, and presence of a familial polytumor syndrome. HD instability was assessed by measuring the number and time period MAP was below 60 mm Hg and systolic BP (SBP) was above 160 mm Hg.Results: A correlation was found between the intraoperative time periods of SBP above 160 mm Hg and plasma norepinephrine levels (r = 0.23; P < 0.05), tumor diameter (r = 0.36; P < 0.01), and postural BP fall (r = 0.30; P < 0.05). MAP at presentation and after alpha-blockade above 100 mm Hg(BP, 130/85 mm Hg) was related to more and longer episodes with a SBP above 160 mm Hg(P < 0.01). Type of operation or alpha-blockade and presence of a familial polytumor syndrome were not related to intraoperative HD instability. Postoperative MAP was lower in the DOX group than in the PXB group (P < 0.05).Conclusion: Risk factors for HD instability during surgery for pheochromocytoma include a high plasma NE concentration, larger tumor size, more profound postural BP fall after alpha-blockade, and a MAP above 100 mm Hg (130/85 mm Hg). Efficacy for preventing HD instability was identical for PXB and DOX. (J Clin Endocrinol Metab 95: 678-685, 2010)