Azadeh N, Ramakrishna H, Bhatia N L, Charles J C, Mookadam F
Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA.
Department of Anesthesia, Mayo Clinic, Phoenix, AZ, USA.
Ir J Med Sci. 2016 Feb;185(1):43-9. doi: 10.1007/s11845-015-1383-5. Epub 2015 Dec 9.
Pheochromocytomas are rare neuroendocrine tumors of the adrenal medulla that may present with protean manifestations. Surgical resection is the mainstay of therapy and patients are at risk of significant hemodynamic and circulatory complications mainly attributable to catecholamine excess. The mainstay of medical therapy in order to optimize patients for surgery includes: alpha-blockers, beta-blockers, calcium channel blocker and other agents to achieve normal blood pressure, heart rate, as well as normal volume status. Understanding the pathophysiology of pheochromocytoma, the pharmacology of medications used, and recognizing postoperative complications will impact patient outcomes.
A multidisciplinary team approach is best throughout the perioperative period to prevent potential complications that arise. The hospital physician, intensivist, anesthetist and cardiovascular specialist play a pivotal role in the management of patients with pheochromocytoma. In addition to the pharmacologic and volume recommendations, a multidisciplinary discussion allows for seamless implementation of an organized plan of care.
嗜铬细胞瘤是肾上腺髓质罕见的神经内分泌肿瘤，可表现出多种症状。手术切除是主要治疗方法，患者有发生严重血流动力学和循环并发症的风险，主要归因于儿茶酚胺过量。为使患者手术条件达到最佳状态，药物治疗的主要手段包括：α受体阻滞剂、β受体阻滞剂、钙通道阻滞剂及其他药物，以实现血压、心率正常以及血容量状态正常。了解嗜铬细胞瘤的病理生理学、所用药物的药理学以及识别术后并发症将影响患者的治疗结果。
在围手术期采用多学科团队方法是预防潜在并发症的最佳方式。医院医生、重症监护医生、麻醉师和心血管专家在嗜铬细胞瘤患者的管理中起着关键作用。除了药物和血容量方面的建议外，多学科讨论有助于有组织的护理计划的无缝实施。
