National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
Stanford University School of Medicine, Stanford, California, USA.
Endocr Relat Cancer. 2020 Sep;27(9):519-527. doi: 10.1530/ERC-20-0139.
Postoperative hypotension frequently occurs after resection of pheochromocytoma and/or paraganglioma (PPGLs). Epidural anesthesia (EA) is often used for pain control in open resection of these tumors; one of its side effects is hypotension. Our aim is to determine if EA is associated with an increased risk of postoperative hypotension after open resection of PPGLs. We conducted a retrospective review of patients who underwent open resection of PPGLs at the National Institutes of Health from 2004 to 2019. Clinical and perioperative parameters were analyzed by the use of EA. The primary endpoint was postoperative hypotension. Ninety-seven patients (46 female and 51 male; mean age, 38.5 years) underwent open resection of PPGLs and 69 (71.1%) received EA. Patients with EA had a higher rate beta-blocker use (79.7% vs 57.1%, P = 0.041), metastasis (69.6% vs 39.3%, P = 0.011), and were more frequently hypotensive after surgery (58.8% vs 25.0%, P = 0.003) compared to those without EA. Patients with postoperative hypotension had higher plasma normetanephrines than those without (7.3 fold vs 4.1 fold above the upper limit of normal, P = 0.018). Independent factors associated with postoperative hypotension include the use of beta-blockers (HR = 3.35 (95% CI: 1.16-9.67), P = 0.026) and EA (HR = 3.49 (95% CI: 1.25-9.76), P = 0.017). Data from this retrospective study suggest that, in patients with open resection of PPGLs, EA is an independent risk factor for early postoperative hypotension. Special caution is required in patients on beta-blockade. A prospective evaluation with standardized protocols for the use of EA and management of hemodynamic variability is necessary.
术后低血压在嗜铬细胞瘤和/或副神经节瘤（PPGL）切除后经常发生。硬膜外麻醉（EA）常用于这些肿瘤的开放性切除以控制疼痛；其副作用之一是低血压。我们的目的是确定 EA 是否与 PPGL 开放性切除术后低血压的风险增加有关。我们对 2004 年至 2019 年期间在美国国立卫生研究院接受 PPGL 开放性切除术的患者进行了回顾性研究。通过使用 EA 分析临床和围手术期参数。主要终点是术后低血压。97 例患者（46 名女性和 51 名男性；平均年龄 38.5 岁）接受了 PPGL 的开放性切除术，其中 69 例（71.1%）接受了 EA。接受 EA 的患者β受体阻滞剂使用率更高（79.7% vs 57.1%，P=0.041），转移率更高（69.6% vs 39.3%，P=0.011），术后低血压发生率更高（58.8% vs 25.0%，P=0.003）。与未接受 EA 的患者相比，术后发生低血压的患者血浆去甲变肾上腺素水平更高（7.3 倍 vs 正常上限以上 4.1 倍，P=0.018）。与术后低血压相关的独立因素包括使用β受体阻滞剂（HR=3.35（95%CI：1.16-9.67），P=0.026）和 EA（HR=3.49（95%CI：1.25-9.76），P=0.017）。这项回顾性研究的数据表明，在接受 PPGL 开放性切除术的患者中，EA 是早期术后低血压的独立危险因素。对接受β受体阻滞剂治疗的患者应特别小心。需要使用 EA 进行标准化协议评估，并对血液动力学变异性进行管理。
