摘要
目的评估肾上腺偶发嗜铬细胞瘤患者术中血流动力学不稳定的危险因素.方法 回顾性分析2001年1月至2018年7月我院行手术治疗的80例肾上腺偶发嗜铬细胞瘤患者的临床资料.男39例,女41例;年龄13~ 76岁,平均45.1岁;肿瘤长径1.5 ~14.0 cm,中位值5.1 cm;左侧25例,右侧55例.合并冠心病或糖尿病或体重指数≥24 kg/m2者37例.根据患者术中血流动力学是否稳定将患者分为血流动力学稳定组(HS组)和血流动力学不稳定组(HI组).比较两组一般资料的差异,采用logistic回归分析术中出现血流动力学不稳定的危险因素.结果 HS组54例(67.5%),HI组26例(32.5%).单因素分析结果显示HS组与HI组年龄[(44.06±13.58)岁与(47.35 ±16.11)岁]、合并冠心病或糖尿病或体重指数≥24 kg/m2的比例[50.0% (27/54)与38.5%(10/26)]、肿瘤长径[中位值5.0 cm(1.5~ 14.0 cm)与6.0 cm(1.5 ~13.5 cm)]、肿瘤位置[左侧:29.6% (16/54)与34.6% (9/26)]、术前儿茶酚胺检测阳性[44.4%(20/45)与50.0%(10/20)]、手术方式[开放:27.8% (15/54)与34.6% (9/26)]及术前未服用α受体阻滞剂比例[13.0% (7/54)与30.8% (8/26)]的差异均无统计学意义(P>0.05).进一步将以上7个变量做多因素logistic回归分析,结果显示患者术前未服用α受体阻滞剂是血流动力学不稳定的独立危险因素(OR=4.574,95%CI 1.273~16.432,P=0.020).结论 肾上腺偶发嗜铬细胞瘤患者术前未服用α受体阻滞剂是术中血流动力学不稳定的独立危险因素.肾上腺偶发瘤患者,尤其是未能排除嗜铬细胞瘤的患者建议术前服用α受体阻滞剂.
Objective To evaluate the risk factors for intraoperative hemodynamic instability (HI) in patients with adrenal incident pheochromocytoma. Methods Perioperative clinical parameters of patients undergoing surgery for adrenal incident pheochromocytoma at the First Hospital of Peking University from January 2001 to July 2018 were analyzed. There were 39 males and 41 females, with mean age of 45. 1 years (13 -76 years old). The median tumor length was 5. 1 cm ( 1.5 - 14. 0 cm), with 25 cases ( 31.3%) on the left side , 55 cases ( 68. 8%) on the right side. There were 37 cases combined with coronaiy heart disease or diabetes or BMI≥24 kg/m2. Patients were divided into hemodynamic instability ( HI group) and hemodynamic stability group ( HS group) by whether intraoperative hemodynamic instability occurred. The differences of demographic ( haracteristics and clinical parameters between the two groups were compared.Logistic regression analysis was done for seeking the risk factors for hemodynamic instability during surgery. Results There were 54 cases ( 67. 5%) in the HS group and 26 cases ( 32. 5%) in the HI group. Univariate analysis showed that there was no significant difference in age [(44. 06 ± 13. 58 ) years old vs.(47. 35 ± 16. 11 ) years old], combined with coronary heart disease or diabetes or BMIM24 kg/ni2 [50. 0%(27/54) vs. 38. 5%( 10/26)], tumor long diameter [ median 5.0 cm( 1.5 - 14. 0 cm) vs. 6. 0cm( 1.5- 13.5 cm)], tumor location[ left :29. 6%( 16/54) vs. 34. 6%(9/26)], preoperative catecholamine test positive [44.4%(20/45) vs. 50.0%(10/20)], open surgery [27.8%( 15/54) vs. 34.6%(9/26)] and preoperative non-alpha blockers [ 13. 0%(7/54) vs. 30. 8%( 8/26)] between HS group and HI group (P > 0. 05 ). Further logistic regression analysis was used to analyze the risk factors of intraoperative hemodynamic instability. Multivariate analysis found that patients who preoperative non-alpha blockers before surgery were independent risk factor for HI ( OR =4.574, 95% CI 1.273 - 16.432, P =0. 020). Conclusions Preoperative non-alpha blocker in patients with adrenal incidental pheochromocytoma could be independent risk factor for intraoperative hemodynamic instability. Therefore, it is recommended that patients with adrenal incidental tumors, especially those who fail to rule out pheochromocytoma, take preoperative alpha blockers.
作者
田杰
孔昊
李楠
刘鹭
吴恺
金博
张雷
高莹
王东信
龚侃
周利群
张争
张俊清
Tian Jie;Kong Hao;Li Nan;Liu Lu;Wu Kai;Jin Bo;Zhang Lei;Gao Ying;Wang Dongxin;GongKan;Zhou Liqun;Zhang Zheng;Zhang Junqing(Department of Urology, Peking University First Hospital, Beijing 100034, China;Department ofAnesthesiology, Peking University First Hospital, Beijing 100034, China;Department of Endocrinology,Peking University First Hospital, Beijing 100034, China;Department of Clinical hiboratory, Peking UnirersityFirst Hospital, Beijing 100034, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第4期262-266,共5页
Chinese Journal of Urology
