Ugleholdt Randi, Rasmussen Åse Krogh, Haderslev Pernille A H, Kromann-Andersen Bjarne, Feltoft Claus Larsen
Department of Endocrinology, Copenhagen University Hospital Herlev and Gentofte, Herlev, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Endocr Connect. 2022 May 11;11(5):e210539. doi: 10.1530/EC-21-0539.
Patients with pheochromocytoma and paraganglioma (PPGL) are treated with α-adrenoceptor antagonists to improve peroperative hemodynamics. However, preoperative blood pressure targets differ between institutions. We retrospectively compared per- and postoperative hemodynamics in 30 patients with PPGL that were pretreated with phenoxybenzamine aiming at different blood pressure targets at two separate endocrine departments. All patients were subsequently undergoing laparoscopic surgery at Department of Urology, Herlev University hospital. Fourteen patients were treated targeting to symptomatic and significant orthostatic hypotension and 16 patients to a seated blood pressure below 130/80 mmHg. As a control group, we included 34 patients undergoing laparoscopic adrenalectomy for other reasons. The group titrated to orthostatic hypotension required a higher dose of phenoxybenzamine to achieve the blood pressure target. This group had less intraoperative systolic and diastolic blood pressure fluctuation (Mann-Whitney U test; P < 0.05) and less periods with heart rate above 100 b.p.m. (Mann-Whitney U test; P = 0.04) as compared to the group with a preoperative blood pressure target below 130/80 mmHg. Peroperative use of intravenous fluids were similar between the two groups, but postoperatively more intravenous fluids were administered in the group with a target of ortostatism. Overall, the control group was more hemodynamic stable as compared to either group treated for PPGL. We conclude that phenoxybenzamine pretreatment targeting ortostatic hypotension may improve peroperative hemodynamic stability but causes a higher postoperative requirement for intravenous fluids. Overall, PPGL surgery is related to greater hemodynamic instability compared to adrenalectomy for other reasons.
嗜铬细胞瘤和副神经节瘤（PPGL）患者采用α-肾上腺素能受体拮抗剂进行治疗，以改善围手术期血流动力学。然而，不同机构的术前血压目标有所不同。我们回顾性比较了在两个不同内分泌科室接受苯氧苄胺预处理、目标血压不同的30例PPGL患者的围手术期和术后血流动力学情况。所有患者随后都在Herlev大学医院泌尿外科接受了腹腔镜手术。14例患者的治疗目标是缓解症状并显著改善体位性低血压，16例患者的目标是坐位血压低于130/80 mmHg。作为对照组，我们纳入了34例因其他原因接受腹腔镜肾上腺切除术的患者。滴定至体位性低血压的组达到血压目标所需的苯氧苄胺剂量更高。与术前血压目标低于130/80 mmHg的组相比，该组术中收缩压和舒张压波动较小（曼-惠特尼U检验；P<0.05），心率高于100次/分钟的时间段较少（曼-惠特尼U检验；P = 0.04）。两组围手术期静脉补液情况相似，但术后以体位性低血压为目标的组补液量更多。总体而言，与治疗PPGL的任何一组相比，对照组的血流动力学更稳定。我们得出结论，以体位性低血压为目标的苯氧苄胺预处理可能会改善围手术期血流动力学稳定性，但会导致术后对静脉补液的需求增加。总体而言，与因其他原因进行的肾上腺切除术相比，PPGL手术与更大的血流动力学不稳定性相关。
