Gosse P, Tauzin-Fin P, Sesay M-B, Sautereau A, Ballanger P
Department of Cardiology, Hypertension Unit, Saint André Hospital, University Hospital of Bordeaux, Bordeaux, France.
J Hum Hypertens. 2009 Sep;23(9):605-9. doi: 10.1038/jhh.2008.172. Epub 2009 Feb 19.
The preparation for phaeochromocytoma surgery is a matter of debate. Pre-operative blockade of alpha-1 receptors is increasingly employed in an attempt to reduce the risk of hypertensive episodes, especially during manipulation of the tumour. In this study, we compared the interest of an almost complete blockade of these receptors by high doses of urapidil in comparison with that of moderate doses of this drug. The study was conducted in two consecutive series of 18 patients, the first treated by a moderate dose, and the second by the highest dose tolerated by the patient. The two groups were comparable in other respects. All patients were operated under laparoscopy by the same surgeon and managed by the same anaesthetist using the same protocol. The number of hypertensive peaks was significantly reduced using the high dose of urapidil, with no more hypotensive episodes after tumour removal in this group. The area under the curve of norepinephrine levels as a function of time was significantly larger with the high doses of urapidil, arguing in favour of a more complete blockade of alpha-1 receptors. Our findings indicate the value of aggressive blockade of alpha-1 receptors in preparation for surgery of phaeochromocytoma.
嗜铬细胞瘤手术的术前准备存在争议。术前使用α-1受体阻滞剂越来越普遍，旨在降低高血压发作的风险，尤其是在肿瘤操作过程中。在本研究中，我们比较了高剂量乌拉地尔几乎完全阻断这些受体与中等剂量该药的效果。该研究连续纳入两组各18例患者，第一组接受中等剂量治疗，第二组接受患者能耐受的最高剂量治疗。两组在其他方面具有可比性。所有患者均由同一位外科医生进行腹腔镜手术，并由同一位麻醉师按照相同方案管理。使用高剂量乌拉地尔可显著减少高血压峰值，该组肿瘤切除后不再出现低血压发作。高剂量乌拉地尔作用下，去甲肾上腺素水平随时间变化的曲线下面积显著增大，这表明对α-1受体的阻断更完全。我们的研究结果表明，在嗜铬细胞瘤手术准备中积极阻断α-1受体具有重要价值。
