垂体瘤切除术中三叉神经-心反射的预测因素及对术后患者心脏不良事件的影响  

Predictive factors of trigeminal nerve‑cardiac reflex during pituitary tumor resection and its influence on postoperative car‑diac adverse events

作　　者：王娟[1] 马婷婷 曾敏[1] 董佳[1] 彭宇明[1] Wang Juan;Ma Tingting;Zeng Min;Dong Jia;Peng Yuming(Department of Anesthesiology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院麻醉科,北京100070

出　　处：《国际麻醉学与复苏杂志》2022年第2期165-171,共7页International Journal of Anesthesiology and Resuscitation

基　　金：贝朗麻醉科学研究基金(BBDF-2018-006)。

摘　　要：目的确认垂体瘤切除术中三叉神经-心反射(trigemino-cardiac reflex,TCR)的预测因素及TCR对术后患者心脏不良事件的影响。方法本研究为一项单中心回顾性病例对照研究,回顾性分析2015年10月1日至2020年9月30日首都医科大学附属北京天坛医院择期行垂体瘤切除手术患者资料,收集患者人口学特征、基线信息(心率、MAP、ECG)、手术和麻醉信息、肿瘤特征(肿瘤大小、侵袭性、病理类型)、心肌酶结果、术前或术中抗心律失常药物应用等变量。依照TCR标准筛选病例组患者,即在垂体瘤切除术中,刺激任何三叉神经分支时突然出现的相对心动过缓(心率减慢幅度超过基线值20%)。对照组为术中未发生TCR的垂体瘤手术患者,依据相同年龄和性别、相近的手术日期,以1∶3比例进行病例组对照组匹配。观察两组患者术后心脏不良事件发生率,苏醒期心律失常、高血压或低血压的发生率,术后垂体功能不全、电解质紊乱的发生率,住院时长,ICU停留时长,住院费用。两组之间进行差异性比较,并采用单因素和多因素Logistic回归分析预测TCR发生的危险因素。结果筛选后符合TCR定义标准的患者为22例(0.62%),病例组较对照组肿瘤直径大[(28.6±10.9)mm比(20.5±9.0)mm,P=0.001]、侵袭性肿瘤占比多(86.4%比56.1%,P=0.011)、手术时间长[180(121.5,223.8)min比107(69.5,184.3)min,P=0.008]、肿瘤全切除比例低(45.5%比72.7%,P=0.022),差异均有统计学意义。多因素Logistic分析发现侵袭性肿瘤是垂体瘤手术TCR发生的独立危险因素[比值比(odds ratio,OR)=5.85,95%CI 1.35~25.23,P=0.018]。病例组术后心脏不良事件发生率及麻醉苏醒期心律失常发生率高于对照组(分别为13.6%比0,P=0.014;40.9%比16.7%,P=0.049)。病例组ICU停留时长多于对照组[2.0(1.25,2.00)d比0(0,0),P=0.014],住院费用高于对照组(44100元比32200元,P=0.016)。其余指标差异无统计学意义(P>0.05)。结论侵袭性�Objective To investigate the predictive factors of trigemino‑cardiac reflex(TCR)in pituitary tumor resection and the effect of TCR on cardiac adverse events in patients after surgery.Methods This was a single‑center retrospective case‑control study.Patients undergoing elective pituitary tumor resection from October 1,2015 to September 30,2020 in Beijing Tiantan Hospital,Capital Medical University were enrolled and their data were retrospective analyzed.Their demographic characteristics,baseline infor‑mation(heart rate,mean arterial pressure,and electrocardiogram),surgical and anesthesia information,tumor characteristics(tumor size,invasion,and pathologic type),myocardial enzyme,and preoperative or intraoperative antiarrhythmic drug used were collected.Pa‑tients in the case group were screened according to the TCR criteria for sudden relative bradycardia(deceleration of heart rate more than 20%of baseline)when stimulating any branch of the trigeminal nerve during pituitary resection.The control group was defined as patients received pituitary adenomas resection without intraoperative TCR.The case and control groups were matched according to age,sex,and mostly closed date of surgery at the ratio of 1∶3.The incidence of postoperative cardiac adverse events,arrhythmia and hyper‑tension/hypotension during recovery from anesthesia,postoperative pituitary insufficiency,electrolyte disorder,length of hospitalization stay,length of intensive care unit(ICU)stay,and hospitalization cost were observed in the two groups.The differences between the two groups were compared,and the risk factors for predicting TCR were predicted by univariate and multivariate logistic regression.Re‑sults A total of 22 patients(0.62%)met the TCR definition criteria.Compared with the control group,the case group had larger tumor di‑ameter[(28.6±10.9)mm vs(20.5±9.0)mm,P=0.001],more invasive tumors(86.4%vs 56.1%,P=0.011),longer surgical duration[180(121.5,223.8)min vs 107(69.5,184.3)min,P=0.008],and a low total resection rate(45.

关 键 词：三叉神经-心反射 心脏不良事件 垂体瘤 

分 类 号：R736.4[医药卫生—肿瘤]