β-肾上腺素能激动剂的给予与类癌肿瘤患者的类癌危象的二次发作无关。

Β-Adrenergic agonist administration is not associated with secondary carcinoid crisis in patients with carcinoid tumor.

机构信息

Division of Surgical Oncology, Oregon Health & Science University, United States.

Department of Anesthesiology & Perioperative Medicine, Oregon Health & Science University, United States.

出版信息

Am J Surg. 2019 May;217(5):932-936. doi: 10.1016/j.amjsurg.2018.12.070. Epub 2019 Jan 3.

DOI:10.1016/j.amjsurg.2018.12.070

PMID:30635207

Abstract

BACKGROUND

Patients with carcinoid tumors are at risk for profound intraoperative hypotension known as carcinoid crisis, which catecholamines are traditionally believed to trigger. However, data supporting this are lacking.

METHODS

Anesthesia records were retrospectively reviewed for carcinoid patients treated with vasopressors. Hemodynamics for those with crisis were compared between those who received β-adrenergic agonists (B-AA) versus those who did not.

RESULTS

Among 293 consecutive operations, 58 were marked by 161 crises. There was no significant difference in the incidence of paradoxical hypotension with B-AA compared to non-B-AA (p = 0.242). The maximum percent decrease in mean arterial pressure following drug administration was significantly greater in those patients treated with non-B-AA than with B-AA (31.6% vs. 12.5%, p < 0.0001). There were no differences in crisis duration (p = 0.257) or postoperative complication rate (p = 0.896).

CONCLUSIONS

β-Adrenergic agonist use was not associated with paradoxical hypotension, prolonged carcinoid crisis, or postoperative complications in patients with intraoperative carcinoid crisis.

摘要

背景

类癌肿瘤患者有发生严重术中低血压的风险，即类癌危象，传统上认为儿茶酚胺会引发这种危象。然而，缺乏支持这一观点的数据。

方法

回顾性审查接受血管加压药物治疗的类癌患者的麻醉记录。比较发生危象的患者中使用β-肾上腺素能激动剂（B-AA）与未使用 B-AA 的患者之间的血流动力学变化。

结果

在 293 例连续手术中，有 58 例出现 161 次危象。使用 B-AA 与非 B-AA 相比，发生矛盾性低血压的发生率无显著差异（p=0.242）。与使用 B-AA 的患者相比，使用非 B-AA 的患者在药物治疗后平均动脉压的最大百分比下降幅度显著更大（31.6%比 12.5%，p<0.0001）。危象持续时间（p=0.257）或术后并发症发生率（p=0.896）无差异。