Prakash Pradeep, Ramachandran Rashmi, Tandon Nikhil, Kumar Rajeev
Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
Department of Anesthesiology and Intensive Care, All India Institute of Medical Sciences, New Delhi, India.
Indian J Urol. 2019 Jan-Mar;35(1):34-40. doi: 10.4103/iju.IJU_190_18.
Pheochromocytoma surgery is associated with significant hemodynamic and metabolic changes that require post-operative monitoring. We prospectively evaluated the trends of blood pressure, blood sugar, body mass index (BMI), and quality of life (QoL) changes in a cohort of patients undergoing pheochromocytoma surgery to determine the minimum duration of monitoring and assess factors that could predict these changes.
Consecutive patients undergoing surgery for pheochromocytoma over a 20-month period were included in this ethics review board-approved, prospective cohort study. Blood pressure and sugar levels were serially monitored using a fixed protocol in the perioperative period and subsequently at 3 months after surgery. BMI and QoL (using World Health Organization Quality of Life [WHOQOL-BREF] questionnaire) were recorded at baseline and 3 months. Changes were compared and assessed for the predictive factors.
Twenty-six patients undergoing 31 procedures were included in the study of whom 8 (30%) developed hypotension and 4 (15%) developed hypoglycemia after surgery. All hypotension episodes occurred within 6 hours of surgery. However, while 3 of the 4 patients who developed hypoglycemia manifest in the first 4 h after surgery, one occurred after 12 h. Occurrence of hypotension correlated with preoperative 24-h urinary vanillylmandelic acid (VMA) levels ( = 0.02) and the total daily dose of prazosin ( = 0.04). Out of 21 hypertensive patients, 7 (33%) had persistent hypertension (HTN) at 3 months and this was associated with age ( = 0.04) and diabetes mellitus (DM) at presentation ( = 0.04). Among six diabetic patients, 1 (16%) had persistent DM. There was significant increase in the BMI ( < 0.0001) and in WHOQOL-BREF scores postoperatively.
Hypotension occurs in 30% patients and hypoglycemia in 15% after pheochromocytoma surgery. Hypotension occurs immediately but hypoglycemia may manifest upto 12h after surgery. Older, diabetic patients are more likely to have persistent HTN. Surgery results in increase in BMI and improvement in QoL.
嗜铬细胞瘤手术会伴随显著的血流动力学和代谢变化，术后需要进行监测。我们前瞻性地评估了一组接受嗜铬细胞瘤手术患者的血压、血糖、体重指数（BMI）和生活质量（QoL）变化趋势，以确定最短监测时长，并评估可预测这些变化的因素。
本前瞻性队列研究纳入了在20个月期间连续接受嗜铬细胞瘤手术的患者，该研究经伦理审查委员会批准。围手术期按照固定方案连续监测血压和血糖水平，术后3个月也进行监测。在基线和术后3个月记录BMI和QoL（使用世界卫生组织生活质量简表[WHOQOL - BREF]问卷）。对变化情况进行比较，并评估预测因素。
本研究纳入了26例接受31台手术的患者，其中8例（30%）术后出现低血压，4例（15%）术后出现低血糖。所有低血压发作均发生在术后6小时内。然而，4例发生低血糖的患者中，3例在术后最初4小时内出现，1例在术后12小时出现。低血压的发生与术前24小时尿香草扁桃酸（VMA）水平（P = 0.02）和哌唑嗪每日总剂量（P = 0.04）相关。21例高血压患者中，7例（33%）在3个月时仍有持续性高血压（HTN），这与年龄（P = 0.04）和就诊时的糖尿病（DM）（P = 0.04）有关。6例糖尿病患者中，1例（16%）仍有持续性DM。术后BMI（P < 0.0001）和WHOQOL - BREF评分显著增加。
嗜铬细胞瘤手术后30%的患者出现低血压，15%的患者出现低血糖。低血压立即出现，但低血糖可能在术后12小时内出现。年龄较大、患有糖尿病的患者更有可能出现持续性HTN。手术导致BMI增加和QoL改善。
