Chen Si, Xu Jing Jing, Gu Guang Chao, Zhang Yue Lun, Shao Jiang, Zeng Rong, Song Xiao Jun, Huang Yu Guang, Zheng Yue Hong
Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China.
Department of Biomedical Engineering,School of Medicine,Tsinghua University,Beijing 100084,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2021 Apr 28;43(2):199-204. doi: 10.3881/j.issn.1000-503X.12976.
Objective To investigate the risk factors for patients using intraoperative vasopressor infusions during carotid body tumor(CBT)excision.Patients' mean arterial pressure(MAP)and heart rate(HR)fluctuations as well as their requirements for vasoactive agents during surgery were assessed. Methods The patients receiving CBT excision in Peking Union Medical College Hospital from May 1,2013 to July 31,2017 were included for a retrospective cohort study.The potential factors of intraoperative requirement for vasopressor infusions were investigated using univariate analysis and Logistic multivariate analysis.Furthermore,the relationships of Shamblin types of CBT with intraoperative MAP/HR fluctuations and requirements for vasoactive agents were analyzed. Results A total of 108 patients with 116 CBTs were included.Univariate analysis revealed that maximum tumor diameter >4 cm,intraoperative internal carotid artery injury,internal carotid artery reconstruction,malignant pathology,advanced Shamblin types(type Ⅱ and Ⅲ),estimated blood loss ≥400 ml,and operation duration >4 hours were associated with intraoperative requirements for vasopressor infusions.Logistic analysis showed that Shamblin type Ⅲ(OR=2.286,95% CI=1.324-14.926,P=0.016)and operation duration >4 hours(OR=3.874,95% CI=1.020-14.623,P=0.046)were risk factors for intraoperative requirements for vasopressor infusions during CBT surgery.In addition,Shamblin type Ⅲ was associated with intraoperative abnormal HR elevation and requirements for vasopressors.Conclusions Shamblin type Ⅲ and operation duration>4 hours are risk factors for intraoperative requirements of patients for using vasopressor infusions during CBT surgery.Shamblin type Ⅲ is associated with intraoperative abnormal HR elevation and requirements for vasopressors.
目的 探讨颈动脉体瘤（CBT）切除术中使用血管升压药输注的患者的危险因素。评估患者的平均动脉压（MAP）和心率（HR）波动情况以及他们在手术期间对血管活性药物的需求。方法 纳入2013年5月1日至2017年7月31日在北京协和医院接受CBT切除的患者进行回顾性队列研究。采用单因素分析和Logistic多因素分析研究术中血管升压药输注需求的潜在因素。此外，分析CBT的Shamblin分型与术中MAP/HR波动及血管活性药物需求的关系。结果 共纳入108例患者的116个CBT。单因素分析显示，肿瘤最大直径>4 cm、术中颈内动脉损伤、颈内动脉重建、恶性病理、Shamblin分型晚期（Ⅱ型和Ⅲ型）、估计失血量≥400 ml以及手术时间>4小时与术中血管升压药输注需求相关。Logistic分析表明，ShamblinⅢ型（OR=2.286，95%CI=1.324-14.926，P=0.016）和手术时间>4小时（OR=3.874，95%CI=1.020-14.623，P=0.046）是CBT手术中术中血管升压药输注需求的危险因素。此外，ShamblinⅢ型与术中HR异常升高及血管升压药需求相关。结论 ShamblinⅢ型和手术时间>4小时是CBT手术中患者术中血管升压药输注需求的危险因素。ShamblinⅢ型与术中HR异常升高及血管升压药需求相关。
