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[一名需要长期血液透析的慢性肾衰竭患者嗜铬细胞瘤切除术的围手术期管理]

[The perioperative management for pheochromocytoma resection in a patient with chronic renal failure requiring long-term hemodialysis].

作者信息

Yamane Kochi, Toda Yuichiro, Egi Moritoki, Sato Tetsufumi, Goto Keiji, Katayama Hiroshi, Morita Kiyoshi

机构信息

Department of Anesthesiology and Resuscitology, Okayama University Hospital, Okayama 700-8558.

出版信息

Masui. 2010 Aug;59(8):1021-4.

Abstract

We report the perioperative management of a 55-year-old man with chronic renal failure requiring long-term hemodialysis, who underwent laparoscopic adrenalectomy for pheochromocytoma. He was pretreated with doxazosin, a calcium channel blocker and a beta-adrenoceptor antagonist to control blood pressure until surgery. His dry weight increased slowly from 57 kg to 58.5 kg for a month increasing the intravascular volume. Neither did the patient develop pulmonary edema nor congestive heart failure preoperatively. Tumor resection was successfully completed under general anesthesia. Although noraderenaline was required to keep adequate blood pressure during surgery and the first day of intensive care unit stay, there was no adverse event during perioperative period. The increasing intravascular volume before pheochromocytoma surgery in a patient on hemodialysis might make the perioperative management safer, although further study is required to determine the adequate level of increment in the preoperative dry weight.

摘要

我们报告了一名55岁患有慢性肾衰竭且需要长期血液透析的男性患者的围手术期管理情况,该患者因嗜铬细胞瘤接受了腹腔镜肾上腺切除术。术前使用多沙唑嗪、一种钙通道阻滞剂和一种β-肾上腺素能受体拮抗剂进行预处理以控制血压直至手术。他的干体重在一个月内从57千克缓慢增加至58.5千克,血管内容量增加。术前患者既未发生肺水肿也未出现充血性心力衰竭。在全身麻醉下成功完成了肿瘤切除。尽管在手术期间及重症监护病房停留的第一天需要去甲肾上腺素来维持足够的血压,但围手术期未发生不良事件。对于接受血液透析的患者,在嗜铬细胞瘤手术前增加血管内容量可能会使围手术期管理更安全,尽管需要进一步研究来确定术前干体重的适当增加水平。

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