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[嗜铬细胞瘤切除患者的血流动力学和儿茶酚胺变化]

[Behavior of hemodynamics and catecholamines in patients undergoing excision of pheochromocytoma].

作者信息

Huemer G, Hlozanek C, Lackner F, Roka R, Schernthaner G, Schwarz S, Templ H

机构信息

Klinik für Anästhesie und allgemeine Intensivmedizin, Universität Wien.

出版信息

Acta Med Austriaca. 1988;15(4):101-3.

PMID:3213375
Abstract

In order to investigate the relation between catecholamine output and haemodynamics, 13 patients aged between 16 and 62 years, who were operated for active pheochromocytoma, were investigated. Patients had general anesthesia employing muscle relaxants, artificial ventilation with nitrous oxide/oxygen and predominantly intravenous analgetics. Before surgery 9 patients had increased norepinephrine blood levels and only 6 patients increased epinephrine levels. Intraoperatively an increase in pulse rate and blood pressure was found, although alpha- and beta-blockers were employed. At this time there was a massively increased level of epinephrine and norepinephrine, both however decreasing at the conclusion of surgery going along with a normalisation of cardial parameters. Comparing norepinephrine to cardiovascular parameters, the best correlation could be found between norepinephrine and mean arterial pressure, followed by total catecholamines and mean arterial pressure. Heart rate showed a smaller correlation coefficient to norepinephrine, followed by norepinephrine and total peripheral resistance. It is concluded that invasive haemodynamic monitoring helps to differentiate between haemodynamic disturbances and to improve the cardiovascular management, although direct relations between blood catecholamine levels and circular vascular parameters could not be found.

摘要

为了研究儿茶酚胺分泌与血流动力学之间的关系,我们对13例年龄在16至62岁之间、因活动性嗜铬细胞瘤接受手术的患者进行了调查。患者采用肌肉松弛剂进行全身麻醉,使用氧化亚氮/氧气进行人工通气,并主要采用静脉镇痛剂。术前9例患者去甲肾上腺素血水平升高,仅6例患者肾上腺素水平升高。术中发现尽管使用了α和β受体阻滞剂,但脉搏率和血压仍有升高。此时,肾上腺素和去甲肾上腺素水平大幅升高,但在手术结束时两者均下降,同时心脏参数恢复正常。将去甲肾上腺素与心血管参数进行比较,发现去甲肾上腺素与平均动脉压之间的相关性最佳,其次是总儿茶酚胺与平均动脉压。心率与去甲肾上腺素的相关系数较小,其次是去甲肾上腺素与总外周阻力。结论是,有创血流动力学监测有助于区分血流动力学紊乱并改善心血管管理,尽管未发现血儿茶酚胺水平与循环血管参数之间的直接关系。

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