Department of Anesthesiology, Medical Hospital of Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
Department of Anesthesiology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.
J Clin Anesth. 2014 Dec;26(8):616-22. doi: 10.1016/j.jclinane.2014.06.005. Epub 2014 Oct 18.
To determine the relationship between preoperative catecholamine levels and intraoperative peak plasma lactate levels in patients who underwent adrenalectomy for pheochromocytoma.
Retrospective observational study.
Operating room in one university hospital.
The records of 27 ASA physical status 1 and 2 patients who underwent adrenalectomy for pheochromocytoma were studied. Preoperative catecholamine levels and intraoperative plasma lactate levels were recorded.
Twenty cases had high lactate levels (>2 mmol/L). Preoperative urine epinephrine levels and urine metanephrine levels showed a moderate correlation with intraoperative peak plasma lactate levels (rs = 0.475 and rs = 0.499, respectively; Spearman's rank correlation test). Receiver operating characteristic (ROC) curve analysis for preoperative urine epinephrine levels showed good performance for prediction of high lactate levels [>2 mmol/L, area under the curve (AUC) =0.800], whereas ROC for preoperative urine norepinephrine levels showed no predictive performance for high lactate levels.
Catecholamine release caused by surgical manipulation may be a possible cause of intraoperative transient lactic acidosis, and it should be considered as a differential diagnosis of intraoperative lactic acidosis. Intraoperative peak plasma lactate level was correlated with preoperative epinephrine-releasing activity.
确定接受嗜铬细胞瘤切除术的患者术前儿茶酚胺水平与术中血浆乳酸峰值水平之间的关系。
回顾性观察性研究。
一所大学医院的手术室。
研究了 27 例接受嗜铬细胞瘤切除术的 ASA 身体状况 1 级和 2 级患者的记录。记录了术前儿茶酚胺水平和术中血浆乳酸水平。
20 例患者的乳酸水平较高（>2mmol/L）。术前尿肾上腺素水平和尿间甲肾上腺素水平与术中血浆乳酸峰值水平呈中度相关（rs=0.475 和 rs=0.499，Spearman 等级相关检验）。术前尿肾上腺素水平的受试者工作特征（ROC）曲线分析显示对高乳酸水平（>2mmol/L，曲线下面积（AUC）=0.800）的预测性能良好，而术前尿去甲肾上腺素水平的 ROC 曲线对高乳酸水平没有预测性能。
手术操作引起的儿茶酚胺释放可能是术中一过性乳酸酸中毒的一个可能原因，应将其作为术中乳酸酸中毒的鉴别诊断之一。术中血浆乳酸峰值水平与术前释放肾上腺素的活性相关。
