Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg Eppendorf University Hospital, Martinistr. 52, 20246, Hamburg, Germany.
World J Urol. 2013 Apr;31(2):371-6. doi: 10.1007/s00345-011-0788-7. Epub 2011 Nov 26.
We investigated hemodynamics in patients receiving delta-Aminolevulinic acid (delta-ALA) to visualize tumor margins prior to radical retro pubic prostatectomy.
Twenty patients undergoing elective open radical retro pubic prostatectomy (RRP).
Cohort observational study. Ten patients receiving 20 mg/kg of delta-ALA orally prior to surgery (delta-ALA) and 10 patients undergoing RRP without the application of delta-ALA served as a retrospectively matched cohort (CONTROL).
Changes in heart rate (HR), mean arterial blood pressure (MAP), and functional hemodynamic parameters were assessed by electrocardiogram, non-invasive and invasive blood pressure monitoring plus transcardiopulmonary thermodilution.
Patients of both groups did not differ in means of age, body mass index, or ASA classification. During surgery, HR and MAP did not differ significantly between both groups. Also, the amount of IV crystalloids and colloids did not differ significantly. In contrast, the amount of vasopressor necessary to maintain MAP within the target range of 70-90 mmHg was significantly higher in delta-ALA when compared to CONTROL (0.08 ± 0.04 μg/kg/min (delta-ALA) vs. 0.03 ± 0.02 μg/kg/min (CONTROL); P < 0.01). Immediately after surgery, patients of delta-ALA showed a significantly higher heart rate (82 ± 18 min(-1) vs. 67 ± 9 min(-1); P < 0.05) compared to patients of CONTROL. Cardiac index, global end-diastolic volume index, and extravascular lung water index were significantly higher after surgery, when compared to baseline values (P < 0.05).
Orally administered delta-ALA prior to open radical prostatectomy induces hemodynamic instability in the perioperative period requiring vasopressor support. Further, an increase of extravascular lung water points toward an increased vascular permeability induced by delta-ALA.
我们研究了接受δ-氨基酮戊酸（δ-ALA）以在根治性耻骨后前列腺切除术之前可视化肿瘤边缘的患者的血液动力学。
20 名接受选择性开放根治性耻骨后前列腺切除术（RRP）的患者。
队列观察研究。10 名患者术前口服 20mg/kg 的 δ-ALA（δ-ALA 组），10 名接受 RRP 且未应用 δ-ALA 的患者作为回顾性匹配队列（对照组）。
通过心电图、非侵入性和侵入性血压监测以及经心肺热稀释法评估心率（HR）、平均动脉血压（MAP）和功能血液动力学参数的变化。
两组患者的年龄、体重指数或 ASA 分类均值无差异。手术期间，两组之间的 HR 和 MAP 无显著差异。此外，维持 MAP 在 70-90mmHg 目标范围内所需的静脉晶体和胶体量也无显著差异。相反，与对照组相比，δ-ALA 组维持 MAP 所需的血管加压药剂量明显更高（0.08±0.04μg/kg/min（δ-ALA）比 0.03±0.02μg/kg/min（对照组）；P<0.01）。手术结束后，与对照组相比，δ-ALA 组患者的心率明显更高（82±18min(-1)比 67±9min(-1)；P<0.05）。与基础值相比，术后心指数、全心舒张末期容积指数和血管外肺水指数均显著升高（P<0.05）。
在根治性前列腺切除术前行口服 δ-ALA 会导致围手术期血液动力学不稳定，需要血管加压药支持。此外，血管外肺水的增加表明 δ-ALA 诱导的血管通透性增加。
