Li N, Kong H, Zhu S N, Li S L, Wang D X
Department of Critical Care Medicine, Peking University First Hospital, Beijing 100034, China.
Zhonghua Yi Xue Za Zhi. 2018 Oct 9;98(37):2999-3004. doi: 10.3760/cma.j.issn.0376-2491.2018.37.010.
To investigate the effects of intraoperative hemodynamic instability on postoperative complications of laparoscopic surgery for pheochromocytoma. It was a retrospective cohort study. According to inclusion/exclusion criteria, adult patients underwent laparoscopic surgery for pheochromocytoma from January 2005 to December 2017 in Peking University First Hospital were enrolled in this study. Eligible patients were divided into two groups by evidence of postoperative complications to find out the effects of intraoperative hemodynamic instability and its' effects on other prognostic indices. The normally distributed continuous variables were compared between two groups by Student's test, Mann-Whitney test were used for the comparison for non-normally distributed continuous variables and χ(2) test for categorical variables. A total of 198 patients were finally enrolled in this study, including 87 males and 111 females with an average age of (47±15) years. Postoperative complications occurred in 17 patients with an incidence of 8.6%, and intraoperative hemodynamic instability occurred in 45 patients (22.7%). It was found that history of stroke[odds ratio ()=13.387, 95% confidence interval (): 2.284-78.460, =0.004], intraoperative hemodynamic instability (=3.351, 95% 1.119-10.039, =0.031) and intraoperative positive fluid balance (for each additional 100 ml) (=1.087, 95% 1.031-1.146, =0.002)were the independent risk factors of postoperative complications of laparoscopic surgery for pheochromocytoma. Furthermore, more postoperative complications, higher rate of admitting to ICU and longer hospital stay was found in patients with hemodynamic instability. Intraoperative hemodynamic instability is an independent risk factor for postoperative complications of laparoscopic surgery in patients with pheochromocytoma, and it associates with more postoperative complications and higher rate of admitting to ICU.
探讨术中血流动力学不稳定对嗜铬细胞瘤腹腔镜手术术后并发症的影响。这是一项回顾性队列研究。根据纳入/排除标准,选取2005年1月至2017年12月在北京大学第一医院接受嗜铬细胞瘤腹腔镜手术的成年患者纳入本研究。符合条件的患者根据术后并发症情况分为两组,以探究术中血流动力学不稳定的影响及其对其他预后指标的影响。两组间正态分布的连续变量采用Student检验进行比较,非正态分布的连续变量采用Mann-Whitney检验进行比较,分类变量采用χ²检验。本研究最终共纳入198例患者,其中男性87例,女性111例,平均年龄(47±15)岁。17例患者发生术后并发症,发生率为8.6%,45例患者(22.7%)术中出现血流动力学不稳定。结果发现,卒中史[比值比(OR)=13.387,95%置信区间(CI):2.284 - 78.460,P = 0.004]、术中血流动力学不稳定(OR = 3.351,95% CI 1.119 - 10.039,P = 0.031)和术中液体正平衡(每增加100 ml)(OR = 1.087,95% CI 1.031 - 1.146,P = 0.002)是嗜铬细胞瘤腹腔镜手术术后并发症的独立危险因素。此外,血流动力学不稳定的患者术后并发症更多、入住ICU的比例更高且住院时间更长。术中血流动力学不稳定是嗜铬细胞瘤患者腹腔镜手术术后并发症的独立危险因素,且与更多的术后并发症和更高的入住ICU比例相关。