Weingarten Toby N, Welch Tasha L, Moore Tamara L, Walters Gulshat F, Whipple Joni L, Cavalcante Alexandre, Bancos Irina, Young William F, Gruber Lucinda M, Shah Muhammad Z, McKenzie Travis J, Schroeder Darrell R, Sprung Juraj
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
Mayo Clinic College of Medicine, School of Health Sciences, Nurse Anesthesia Graduate Programs, Rochester, MN.
Urology. 2017 Feb;100:131-138. doi: 10.1016/j.urology.2016.10.012. Epub 2016 Oct 18.
To determine whether, despite pharmacologic adrenergic receptor blockade, higher preoperative levels of catecholamines and metanephrines (adrenergic activity) are associated with increased intraoperative complications.
Records of patients undergoing paraganglioma and pheochromocytoma (PGL-PCC) resection from January 1, 2000, to June 30, 2015, were reviewed for preoperative levels of adrenergic activity, intraoperative variability in blood pressure and heart rate (range), and postoperative outcomes (hypotension requiring treatment). Patients were categorized by maximum preoperative adrenergic activity by greater degree of abnormality, categorized as normal (≤100%) or 101%-200%, 201%-500%, 501%-1000%, and ≥1001% of upper limit of normal.
In total, 258 patients underwent intrathoracic or intra-abdominal PGL-PCC resection, of whom 240 received pretreatment with nonselective α-blockers and 7 received pretreatment with selective α-blockers. Intraoperative hemodynamic variability was greater with higher preoperative levels of adrenergic activity (P <.001). However, substantial variability was observed even with adrenergic activity levels within the normal range: systolic blood pressure (median [interquartile range], 75 [63-83] mm Hg) and heart rate (34 [26-43] beats per minute). Among patients with preoperative levels of adrenergic activity ≤500% vs ≥501% of the upper limit of normal, higher levels were associated with greater likelihood of postoperative diagnosis of volume overload (8% vs 2%, P = .04) and greater requirement for vasopressor infusions for hypotension (5% vs 1%, P = .01).
Substantial intraoperative hemodynamic instability was encountered in patients with PGL-PCC resection, regardless of preoperative hormonal activity level; therefore, universal preoperative adrenergic receptor blockade should be recommended. Postoperative hypotension was rare and more prevalent in those with higher preoperative hormonal activity.
确定尽管进行了药物性肾上腺素能受体阻滞，但术前较高水平的儿茶酚胺和甲氧基肾上腺素（肾上腺素能活性）是否与术中并发症增加相关。
回顾2000年1月1日至2015年6月30日接受副神经节瘤和嗜铬细胞瘤（PGL-PCC）切除术患者的记录，以了解术前肾上腺素能活性水平、术中血压和心率变异性（范围）以及术后结局（需要治疗的低血压）。根据术前最大肾上腺素能活性按异常程度更高进行分类，分为正常（≤100%）或101%-200%、201%-500%、501%-1000%以及≥1001%正常上限。
共有258例患者接受了胸内或腹内PGL-PCC切除术，其中240例接受了非选择性α受体阻滞剂预处理，7例接受了选择性α受体阻滞剂预处理。术前肾上腺素能活性水平越高，术中血流动力学变异性越大（P <0.001）。然而，即使肾上腺素能活性水平在正常范围内也观察到了显著变异性：收缩压（中位数[四分位间距]，75[63-83]mmHg）和心率（每分钟34[26-43]次）。术前肾上腺素能活性水平≤500%正常上限与≥501%正常上限的患者相比，较高水平与术后容量超负荷诊断可能性更大（8%对2%，P =0.04）以及低血压时血管升压药输注需求更大（5%对1%，P =0.01）相关。
PGL-PCC切除术患者术中出现了显著的血流动力学不稳定，无论术前激素活性水平如何；因此，应推荐普遍进行术前肾上腺素能受体阻滞。术后低血压很少见，在术前激素活性较高的患者中更普遍。
