美托洛尔联合七氟醚治疗嗜铬细胞瘤术中高血压3例  

Successful management of hypertension in anesthesia of pheochromocytoma via the use of metoprolol combined with sevoflurane

作　　者：李礼[1] 曾剑锋[1] 刘春姣 杨艺 

机构地区：[1]中山大学孙逸仙纪念医院麻醉科,广州510289 [2]宁波市北仑区人民医院病理科,浙江宁波315800 [3]宁波市中医院麻醉科,浙江宁波315010

出　　处：《岭南现代临床外科》2017年第4期452-455,共4页Lingnan Modern Clinics in Surgery

基　　金：广东省自然科学(2015A030313178)

摘　　要：目的探讨β受体阻滞剂联合七氟醚对嗜铬细胞瘤术中高血压的治疗效果及安全性分析。方法回顾中山大学孙逸仙纪念医院收治的3例嗜铬细胞瘤患者的临床及手术资料,分析其术前准备、美托洛尔联合七氟醚治疗术均于中高血压后的血流动力学变化及患者转归,并复习相关文献。结果 3例患者术前确诊肾上腺嗜铬细胞瘤,予酚苄明术前准备后,择期气管内插管全麻下行腹腔镜嗜铬细胞瘤切除术。术中在游离肾上腺腺瘤期间,血压分别骤升至170/110 mm Hg、160/90 mm Hg及160/90 mm Hg,在加深麻醉深度的同时予美托洛尔分次静脉推注后,血压可逐渐下降至基础水平,无反跳现象。患者无明显术后低血压,术后6~8天出院。结论嗜铬细胞瘤术中高血压,在加深麻醉的同时或可考虑联合使用β受体阻滞剂降压,但其有效性及安全性仍需日后进一步的观察和研究。Objective To explore the efficiency and risks of β blocker combined with sevoflurance in the management of hypertension in pheochromocytoma surgery. Methods Clinical and anaesthetic data from 3 cases of pheochromocytoma were collected. The patients outcomes were recorded and analyzed including preoperative schedule,intraoperative hemodynamic changes after antihypertensive therapy by metoprolol combined with sevoflurane. Related literatures were reviewed. Results Adrenal adenoma was identified as phaeochromocytoma in 3 cases in our hospital. Laparoscopic adrenalectomy was performed,and phenoxybenzamine was given for preoperative preparation. During the surgical excision of the adenoma,severe hypertension occurred;blood pressure were measured as 170/110 mm Hg,160/90 mm Hg and 160/90 mm Hg respectively in three patients. Along with administration of intravenous metoprolol and deepen of the anesthetic depth,blood pressure gradually diminished to the baseline,no rebound phenomena was observed after withdrawal of medication. No post-operative hypotension was observed after transferred to the ward,and all 3 cases were discharged from hospital on the 6th-8th postoperative day. Conclusion β blocker with deepen anesthetic depth could be used for the management of hypertension in anesthesia of pheochromocytoma,of which the efficiency and safety still need further study.

关 键 词：Β受体阻滞剂 美托洛尔 七氟醚 嗜铬细胞瘤 高血压 麻醉 

分 类 号：R614[医药卫生—麻醉学]