术前多沙唑嗪准备时长对嗜铬细胞瘤和副神经节瘤患者术中血流动力学的影响  

Effect of preoperative doxazosin preparation time on intraoperative hemodynamics of patients with phaeochromocytoma or paraganglioma

作　　者：景晓利 陶磊[1] 张富军[1] JING Xiaoli;TAO Lei;ZHANG Fujun(Department of Anesthesiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院麻醉科,上海200025

出　　处：《上海医学》2024年第1期26-33,共8页Shanghai Medical Journal

摘　　要：目的分析在精确麻醉管理模式下,多沙唑嗪术前准备时长对嗜铬细胞瘤(phaeochromocytoma,PCC)和副神经节瘤(paraganglioma,PGL)患者术中血流动力学的影响情况。方法采用回顾性队列研究方法,收集、分析上海交通大学医学院附属瑞金医院2015年1月—2021年1月择期行PCC和PGL切除手术的患者资料。根据纳入、排除标准,共有232例患者被纳入本研究。其中,PCC 199例,PGL 33例。按照患者术前多沙唑嗪准备时长[以天(T)表示]分为4组:组1 T<14 d;组2 T为14~28 d;组3 T为<28~42 d;组4 T>42 d。计算4组术前多沙唑嗪准备时长患者的术中血流动力学不稳定(hemodynamic instability,HI)的发生率。比较非HI与HI患者的一般资料、ASA分级、合并症、术前用药等。观察4组患者的术中收缩压、舒张压、平均动脉压和心率的最大值、最小值及波动范围,术中低血压的发生情况,术中血管活性药物使用情况,以及术中强心药的使用率。采用Clavien-Dindo评分标准评估4组患者的术后早期预后并记录术后住院时间。结果232例患者中,98例发生了HI,纳入HI组,剩余134例纳入非HI组。单因素分析显示,与非HI组比较,HI组ASAⅢ级患者占比、糖尿病患者占比,以及术前最高水平血浆甲氧基肾上腺素和血浆甲氧基去甲肾上腺素的数值显著增高(P值均<0.05)。将单因素分析中P<0.25的变量及术前多沙唑嗪准备时长纳入多因素logistic回归分析,结果显示:患者术前ASA分级高、合并糖尿病是其术中发生HI的危险因素(P值均<0.05),而术前多沙唑嗪准备时长不是术中发生HI的危险因素(P>0.05)。与组1相比,组2、组4患者合并术前高血压的患者占比均显著增高(P值均<0.05/6)。4组术前多沙唑嗪准备时长患者术中HI的发生率、血流动力学各指标水平、麻醉时长、手术时长、强心药物使用情况、液体正平衡水平、各手术方式占比,以及术中使用各类血管活性药物单�Objective To investigate the effect of preoperative doxazosin preparation time on intraoperative hemodynamics of patients with phaeochromocytoma or paraganglioma under accurate anesthesia management mode.Methods A retrospective cohort study was performed in 232 patients who underwent elective phaeochromocytoma or paraganglioma resection at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2021.There were 199 patients with phaeochromocytoma and 33 patients with paraganglioma.According to preoperative doxazosin preparation time(T,days),the patients were divided into 4 groups:T<14 group,14≤T≤28 group,28<T≤42 group,and T>42 group.The incidence of intraoperative hemodynamic instability(HI)was compared among the four groups.The maximum,minimum,and fluctuation of intraoperative SBP,DBP,MAP and heart rate,as well as intraoperative hypotension and the use of vasoactive agents and cardiotonic agents were observed.The Clavien-Dindo scoring was used to evaluate early prognosis and the length of postoperative hospital stay was recorded.Results HI occurred in 98 patients.Univariate analysis showed that the proportions of patients with ASAⅢand diabetes mellitus and preoperative levels of serum metanephrine and normetanephrine in HI group were significantly higher than those in non-HI group(all P<0.05).The variables with P<0.25 in univariate analysis and preoperative doxazosin preparation time were included in multivariate logistic regression analysis,and the result showed that high ASA level and diabetes mellitus were risk factors for intraoperative HI(both P<0.05),but preoperative doxazosin preparation time was not an independent risk factor for intraoperative HI in patients with phaeochromocytoma or paraganglioma(P>0.05).The proportions of patients with a history of hypertension in the 14≤T≤28 group and T>42 group were significantly higher than those in the T<14 group(all P<0.05/6).There were no statistically significant differences in the incidence of intr

关 键 词：嗜铬细胞瘤 副神经节瘤 多沙唑嗪 Α-受体阻滞剂 精确麻醉管理 血流动力学 

分 类 号：R614[医药卫生—麻醉学]