Tauzin-Fin Patrick, Barrucand Kévin, Sesay Musa, Roullet Stéphanie, Gosse Philippe, Bernhard Jean-Christophe, Robert Gregoire, Sztark François
Department of Anesthesia and Critical Care, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France.
Department of Cardiology, CHU Bordeaux, Hôpital Pellegrin, Place Amélie Raba-Léon, Cedex, France.
J Anaesthesiol Clin Pharmacol. 2020 Jan-Mar;36(1):49-54. doi: 10.4103/joacp.JOACP_71_18. Epub 2020 Feb 18.
Surgery for pheochromocytoma (PCC) can cause excessive catecholamine release with severe hypertension. Alpha blockade is the mainstay of preoperative management. The aim of this study was to evaluate the efficacy and tolerance of intra-venous (IV) urapidil, a competitive short acting α1 receptor antagonist, in the prevention of peri-operative hemodynamic instability of patients with PCC.
This retrospective observational study included 75 patients (79 PCC) for PCC removal surgery from 2001 to 2017 at the Bordeaux University Hospital. They received, 3 days before surgery, continuous intravenous infusion of urapidil with stepwise increase to the maximum tolerated dose. Urapidil was maintained during the procedure and stopped after clamping the adrenal vein. Plasma catecholamine concentrations were measured during surgery. Hypertensive peaks (SAP >160 mmHg) and tachycardia >100 beats/min were treated with boluses of nicardipine 2 mg and esmolol 0.5 mg/kg.
We recorded 20/79 (25%) cases with systolic arterial pressure (SAP) >180 mmHg. Only 11/79 (14%) had hypotension with SAP <80 mmHg. Peaks of catecholamine secretions were observed preferentially during peritoneal insufflation and tumor dissection ( < 0.05). A correlation was found between tumor size (mm) and the highest norepinephrine levels [ = 0.288, = 0.015], and between hypertensive peaks (mmHg) and the highest norepinephrine levels [ = 0.45, = 0.017]. No mortality was reported. The median [range] postoperative hospital stay was 4 [2-9] days.
IV urapidil limits hypertensive and hypotensive peaks during PCC surgery, and corresponds to surgical imperatives allowing a short hospital stay, due to its "on-off" effect.
嗜铬细胞瘤（PCC）手术可导致儿茶酚胺过度释放，引发严重高血压。α受体阻滞剂是术前管理的主要手段。本研究旨在评估静脉注射乌拉地尔（一种竞争性短效α1受体拮抗剂）预防PCC患者围手术期血流动力学不稳定的疗效和耐受性。
这项回顾性观察性研究纳入了2001年至2017年在波尔多大学医院接受PCC切除手术的75例患者（79个PCC）。他们在手术前3天接受乌拉地尔持续静脉输注，并逐步增加至最大耐受剂量。手术过程中持续使用乌拉地尔，肾上腺静脉结扎后停药。术中测量血浆儿茶酚胺浓度。收缩压>160 mmHg的高血压峰值和心率>100次/分钟的心动过速，分别给予2 mg尼卡地平推注和0.5 mg/kg艾司洛尔治疗。
我们记录到20/79（25%）例收缩压（SAP）>180 mmHg。仅11/79（14%）例出现SAP<80 mmHg的低血压。儿茶酚胺分泌峰值主要出现在气腹和肿瘤剥离期间（P<0.05）。发现肿瘤大小（mm）与最高去甲肾上腺素水平之间存在相关性[r = 0.288，P = 0.015]，高血压峰值（mmHg）与最高去甲肾上腺素水平之间也存在相关性[r = 0.45，P = 0.017]。未报告死亡病例。术后住院时间中位数[范围]为4[2 - 9]天。
静脉注射乌拉地尔可限制PCC手术期间的高血压和低血压峰值，因其“开-关”效应符合手术要求，可实现短期住院。
