Zawadzka Karolina, Więckowski Krzysztof, Małczak Piotr, Wysocki Michał, Major Piotr, Pędziwiatr Michał, Pisarska-Adamczyk Magdalena
Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland.
Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
Eur J Endocrinol. 2021 May 4;184(6):751-760. doi: 10.1530/EJE-20-1301.
Alpha-adrenergic blockade is currently the first choice of preoperative treatment in patients with functional pheochromocytoma and sympathetic paraganglioma. Nevertheless, there is no consensus whether selective or non-selective alpha-blockade is superior for preventing both perioperative hemodynamic instability and complications.
Our study aimed to compare selective and non-selective alpha-blockade through a systematic review with meta-analysis.
MEDLINE, Embase, Web of Science and Cochrane Library were searched for eligible studies. Randomized and observational studies comparing selective and non-selective alpha-blockade in pheochromocytoma and sympathetic paraganglioma surgery in adults were included. Data on perioperative hemodynamic parameters and postoperative outcomes were extracted.
Eleven studies with 1344 patients were enrolled. Patients receiving selective alpha-blockade had higher maximum intraoperative systolic blood pressure (WMD: 12.14 mmHg, 95% CI: 6.06-18.21, P < 0.0001) compared to those treated with non-selective alpha-blockade. Additionally, in the group pretreated with selective alpha-blockers, intraoperative vasodilators were used more frequently (OR: 2.46, 95% CI 1.44-4.20, P = 0.001). Patients treated with selective alpha-blockers had lower minimum intraoperative systolic blood pressure (WMD: -2.03 mmHg, 95% CI: -4.06 to -0.01, P = 0.05) and shorter length of hospital stay (WMD: -0.58 days, 95% CI: -1.12 to -0.04, P = 0.04). Operative time, overall morbidity and mortality did not differ between the groups.
This meta-analysis shows non-selective alpha-blockade was more effective in preventing intraoperative blood pressure fluctuations while maintaining comparable risk of both intraoperative and postoperative hypotension and overall morbidity.
α-肾上腺素能阻滞剂目前是功能性嗜铬细胞瘤和交感神经节细胞瘤患者术前治疗的首选。然而，对于选择性或非选择性α-阻滞剂在预防围手术期血流动力学不稳定和并发症方面哪种更具优势，尚无共识。
我们的研究旨在通过系统评价和荟萃分析比较选择性和非选择性α-阻滞剂。
检索MEDLINE、Embase、科学引文索引和考克兰图书馆以查找符合条件的研究。纳入比较成人嗜铬细胞瘤和交感神经节细胞瘤手术中选择性和非选择性α-阻滞剂的随机和观察性研究。提取围手术期血流动力学参数和术后结果的数据。
纳入了11项研究，共1344例患者。与接受非选择性α-阻滞剂治疗的患者相比，接受选择性α-阻滞剂治疗的患者术中最高收缩压更高（加权均数差：12.14 mmHg，95%可信区间：6.06 - 18.21，P < 0.0001）。此外，在接受选择性α-阻滞剂预处理的组中，术中血管扩张剂的使用频率更高（比值比：2.46，95%可信区间1.44 - 4.20，P = 0.001）。接受选择性α-阻滞剂治疗的患者术中最低收缩压更低（加权均数差：-2.03 mmHg，95%可信区间：-4.06至-0.01，P = 0.05），住院时间更短（加权均数差：-0.58天，95%可信区间：-1.12至-0.04，P = 0.04）。两组之间的手术时间、总体发病率和死亡率无差异。
这项荟萃分析表明，非选择性α-阻滞剂在预防术中血压波动方面更有效，同时在维持术中及术后低血压风险和总体发病率相当的情况下。
