Konno Daisuke, Nishino Ryo, Ejima Yutaka, Ohnishi Eiko, Sato Kuniko, Kurosawa Shin
Department of Anesthesiology, Tohoku University Hospital, Sendai 980-8574.
Masui. 2013 Apr;62(4):421-5.
Intensive perioperative management is required for adrenalectomy in patients with pheocromocytoma because of the unstable hemodynamics and life threatening cardiovascular disturbances due to catecholamine surge from the neuroendocrine tumors. The aim of this study was to assess the perioperative factors contributing to the hemodynamic changes during surgery in pheochromocytoma.
Ten patients with pheochromocytoma undergoing elective adrenalectomy were enrolled in this retrospective study. The circulating blood volume before surgery and the perioperative factors associated with hemodynamic changes during surgery were assessd by the pulse dye densitometry and VigileoTM/ FroTracTM system, respectively.
The decreases of blood pressure after resections of the central veins from tumors were significantly greater in laparotomy than those in laparoscopic surgery (P<0.05). In addition, the decreases of blood pressure after resection of the central were correlated with tumor sizes (R= -0.611), perioperative noradrenaline (NA) blood levels (R= -0.860), perioperative amounts of NA in urine (R= -0.743), and mean stroke volume variations for 5 min after resection of the veins(R= - 0.679).
The decreases of blood pressure after resections of the central veins are dependent on the perioperative blood NA levels, the level of NA in the perioperative urine testig, and tumor sizes.
由于嗜铬细胞瘤患者存在不稳定的血流动力学以及神经内分泌肿瘤释放儿茶酚胺导致的危及生命的心血管紊乱，因此这类患者行肾上腺切除术需要强化围手术期管理。本研究的目的是评估嗜铬细胞瘤手术期间导致血流动力学变化的围手术期因素。
本回顾性研究纳入了10例行择期肾上腺切除术的嗜铬细胞瘤患者。术前循环血容量以及与手术期间血流动力学变化相关的围手术期因素分别通过脉搏染料密度测定法和VigileoTM/FroTracTM系统进行评估。
开腹手术中肿瘤中央静脉切除后血压的下降幅度显著大于腹腔镜手术（P<0.05）。此外，中央静脉切除后血压的下降与肿瘤大小（R = -0.611）、围手术期去甲肾上腺素（NA）血药浓度（R = -0.860）、围手术期尿中NA含量（R = -0.743）以及静脉切除后5分钟的平均每搏量变化（R = -0.679）相关。
中央静脉切除后血压的下降取决于围手术期血中NA水平、围手术期尿NA检测水平以及肿瘤大小。
