Brunaud Laurent, Boutami Myriam, Nguyen-Thi Phi-Linh, Finnerty Brendan, Germain Adeline, Weryha Georges, Fahey Thomas J, Mirallie Eric, Bresler Laurent, Zarnegar Rasa
Department of Digestive, Hepato-Biliary and Endocrine Surgery, CHU Nancy - Hospital Brabois Adultes, University de Lorraine, Nancy, France; Faculty de medicine, INSERM U954, University de Lorraine, Nancy, France.
Department of Digestive and Endocrine Surgery, CCDE, IMAD, CHU Nantes, Université de Nantes, Nantes, France.
Surgery. 2014 Dec;156(6):1410-7; discussion1417-8. doi: 10.1016/j.surg.2014.08.022. Epub 2014 Nov 11.
Alpha-blockade is the standard management preoperatively to prevent intraoperative hemodynamic instability (IHD) during resection of a pheochromocytoma. Calcium channel blockers also have been shown to lessen the risk of IHD. We aim to determine differences between these classes of antihypertensive agents in minimizing IHD.
This was a retrospective analysis from a tri-institutional database. Inclusion criteria were unilateral transabdominal adrenalectomy for pheochromocytomas between 2002 and 2012. IHD was defined as at least one systolic blood pressure (SBP) measurement >160 mm Hg and at least one episode of mean arterial pressure 60 mm Hg.
A total of 155 patients were included: 110 receiving calcium channel blockers, 41 alpha-blockade, and 4 no medication. Intraoperatively, mean maximal SBP was less after alpha-blockade (P < .0001) as well as the incidence and duration of episodes of SBP >200 mm Hg (P < .01); however, severe hypotensive episodes (MAP <60 mm Hg) were more frequent (P < .001) and longer (P < .0001) with alpha-blockade. Consequently, intraoperative vasoactive drugs were used more frequently (P = .03), and mean fluid volume infused was larger (P < .001). Fifty-four patients had IHD, but these were independent of type of preoperative medication used. Familial disease was the only independent predictor of IHD.
IHD was independent of type of preoperative medical management but was dependent on familial disease. These findings broaden options for clinicians in the preoperative management of pheochromocytoma.
α受体阻滞剂是术前预防嗜铬细胞瘤切除术中血流动力学不稳定（IHD）的标准治疗方法。钙通道阻滞剂也已被证明可降低IHD风险。我们旨在确定这些类别降压药物在最小化IHD方面的差异。
这是一项来自三机构数据库的回顾性分析。纳入标准为2002年至2012年间接受单侧经腹肾上腺切除术治疗嗜铬细胞瘤。IHD定义为至少一次收缩压（SBP）测量>160mmHg以及至少一次平均动脉压60mmHg发作。
共纳入155例患者：110例接受钙通道阻滞剂治疗，41例接受α受体阻滞剂治疗，4例未用药。术中，α受体阻滞剂治疗后平均最大SBP较低（P<.0001），SBP>200mmHg发作的发生率和持续时间也较低（P<.01）；然而，α受体阻滞剂治疗时严重低血压发作（MAP<60mmHg）更频繁（P<.001）且持续时间更长（P<.0001）。因此，术中血管活性药物使用更频繁（P=.03），平均输液量更大（P<.001）。54例患者发生IHD，但这些与术前使用的药物类型无关。家族性疾病是IHD的唯一独立预测因素。
IHD与术前医疗管理类型无关，但与家族性疾病有关。这些发现拓宽了临床医生在嗜铬细胞瘤术前管理中的选择。
