术中血流动力学波动对嗜铬细胞瘤和副神经节瘤患者术后并发症的影响  

Impact of intraoperative hemodynamic fluctuation on postoperative complications in patients with pheochromocytoma and paraganglioma surgery

作　　者：龚灿生[1] 李艳珍[2] 杨瑞芝 陈梦楠 邱杭玲 蒋俊丹[1] 郑晓春[1] 林财珠[2] GONG Can-sheng;LI Yan-zhen;YANG Rui-zhi;CHEN Meng-nan;QIU Hang-ling;JIANG Jun-dan;ZHENG Xiao-chun;LIN Cai-zhu(Shengli Clinical College of Fujian Medical University,Department of Anesthesiology of Fujian Provincial Hospital,Fuzhou,Fujian 350001,China;Department of Anesthesiology,First Affiliated Hospital of Fujian Medical University;Department of Anesthesiology,Jianou Hospital of Integrated Traditional Chinese and Western Medicine)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院麻醉科,福建福州350001 [2]福建医科大学附属第一医院麻醉科 [3]福建省南平市建瓯市中西医结合医院麻醉科

出　　处：《中华高血压杂志》2021年第12期1266-1271,共6页Chinese Journal of Hypertension

基　　金：2020年福建医科大学教育教学改革研究项目(J200026);福建省卫生计生青年科研课题项目(2018-1-59)。

摘　　要：目的回顾性分析嗜铬细胞瘤和副神经节瘤(PPGL)患者围术期资料,明确术中血流动力学波动对该类患者术后严重并发症的影响。方法选取2015年1月至2021年1月在福建省立医院进行肿瘤切除手术且术后病理证实为PPGL的患者为研究对象。收集患者人口学特征、术前合并症、术前检查、术前准备、手术情况及术后并发症情况。采用受试者工作特征(ROC)曲线计算术中的收缩压标准差(SBPSD)预测术后严重并发症的最佳截断值,根据该截断值将患者分为剧烈波动组和非剧烈波动组。比较两组患者术后并发症发生率、重症监护病房(ICU)入住率、ICU入住时间及术后住院时间;采用Kaplan-Meier曲线分析两组术后并发症的累积发病率差异,采用Cox回归分析剧烈波动组与非剧烈波动组发生术后并发症的风险比。结果研究共纳入了126例患者,其中剧烈波动组41例,非剧烈波动组85例。与非剧烈波动组相比,剧烈波动组患者术后并发症发生率(58.5%比16.5%,χ^(2)=23.236,P<0.001)及ICU入住率(26.8%比10.6%,χ^(2)=5.463,P=0.019)较高,术后住院时间及ICU入住时间较长(P<0.05)。Kaplan-Meier曲线显示,剧烈波动组术后并发症累积发生率高于非剧烈波动组(χ^(2)=24.404,P<0.001)。多因素Cox比例风险回归分析表明,剧烈波动组发生术后并发症的风险为非剧烈波动组的3.010倍(95%CI 1.334~6.806)。结论对于PPGL患者,术中血流动力学剧烈波动显著增加术后并发症的风险。Objective To identify the effect of hemodynamic fluctuations on severe postoperative complications in patients undergoing surgery for pheochromocytoma and paraganglioma(PPGL).Methods Patients with PPGL confirmed by postoperative pathologic examination in Fujian Provincial Hospital from January 1,2015,to January 31,2021were enrolled.Demographic characteristics,comorbidities,preoperative examinations,preoperative preparation,intraoperative data,and postoperative complications were collected.Receiver operating characteristic(ROC)curve was used to caculate the cut-of point of intraoperative standard deviation of systolic blood pressure(SBPSD)for predit severe postoperative complication.According to the cut-of point,patients were divided into fluctuation group and non-severe fluctuation group.Incidence of postoperative complication,intensive care unit(ICU)admission,length of stay after the operation,and length of ICU stay between the two groups was compared.The cumulative incidence and hazard ratio of postoperative complications were evaluated by Kaplan-Meier method and Cox regression analysis.Results A total of 126patients were finally included in the study,including 41cases in the severe fluctuation group and 85in the non-severe fluctuation group.Compared with the non-severe fluctuation group,the incidence of postoperative complications(58.5%vs 16.5%,χ^(2)=23.236,P<0.001),ICU admission rate(26.8%vs 10.6%,χ^(2)=5.463,P=0.019),postoperative hospital stay and ICU stay were higher in the severe fluctuation group(P<0.05).The Kaplan-Meier curve showed a higher incidence of postoperative complications in patients with severe blood pressure fluctuations(χ^(2)=24.404,P<0.05).The Cox regression analysis also showed that patients in the severe fluctuation group were more prone to postoperative complications(HR=3.010,95%CI 1.334-6.806).Conclusion For patients with PPGL,the intraoperative hemodynamic fluctuations are associated with an increased risk of severe postoperative complications.

关 键 词：嗜铬细胞瘤 副神经节瘤 并发症 血流动力学 波动 

分 类 号：R736.6[医药卫生—肿瘤]