Lan Ling, Shu Qian, Yu Chunhua, Pei Lijian, Zhang Yuelun, Xu Li, Huang Yuguang
Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Front Oncol. 2022 Sep 12;12:979994. doi: 10.3389/fonc.2022.979994. eCollection 2022.
Pheochromocytoma is a rare catecholamine-secreting tumor. Tumor resection remains a high-risk procedure due to intraoperative hemodynamic instability nowadays, which may lead to myocardial injury. We aimed to determine the incidence and associated risk factors for myocardial injury after laparoscopic adrenalectomy for pheochromocytoma.
Adult patients (n=350, American Society of Anesthesiology physical status 1-3) who underwent elective laparoscopic adrenalectomy for pheochromocytoma under general anesthesia between January 31, 2013 and January 31, 2020 were included in this observational, retrospective, single-center, cohort study. Blood troponin I levels were measured before and during the first 2 days after surgery. Myocardial injury was defined as an elevated troponin I level exceeding the 99 percentile upper reference limit due to cardiac ischemic causes.
Myocardial injury occurred in 42/350 patients (12.0%, 95% confidence interval: 9.0%-15.9%). In multivariable analysis (adjusted odds ratios [95% confidence intervals]), previous ischemic heart disease or stroke (5.04 [1.40-18.08]; =0.013), intraoperative heart rate >115 bpm (2.55 [1.06-6.12]; =0.036), intraoperative systolic blood pressure >210 mmHg (2.38 [1.00-5.66]; =0.049), and perioperative decrease in hemoglobin level(1.74 [1.15-2.64] per g/dL decrease; =0.008) were associated with an increased risk of myocardial injury. For the cumulative duration of dichotomized intraoperative hemodynamics, multivariable analysis showed that intraoperative heart rate >115 bpm for >1 minute (2.67 [1.08-6.60]; =0.034) and systolic blood pressure >210 mmHg for >1 minute (3.78 [1.47-9.73]; =0.006) were associated with an increased risk of myocardial injury. The risk of myocardial injury progressively increased with a longer cumulative duration of intraoperative tachycardia and hypertension.
There is a high incidence of myocardial injury after laparoscopic adrenalectomy for pheochromocytoma. The identified risk factors may assist physicians in detecting high-risk patients and providing guidance for intraoperative hemodynamics and perioperative hemoglobin management.
嗜铬细胞瘤是一种罕见的分泌儿茶酚胺的肿瘤。由于目前术中血流动力学不稳定，肿瘤切除仍然是一项高风险手术，这可能导致心肌损伤。我们旨在确定嗜铬细胞瘤腹腔镜肾上腺切除术后心肌损伤的发生率及相关危险因素。
本观察性、回顾性、单中心队列研究纳入了2013年1月31日至2020年1月31日期间在全身麻醉下接受择期嗜铬细胞瘤腹腔镜肾上腺切除术的成年患者（n = 350，美国麻醉医师协会身体状况分级为1 - 3级）。在手术前及术后前两天内测量血肌钙蛋白I水平。心肌损伤定义为因心脏缺血原因导致肌钙蛋白I水平升高超过99百分位上限参考值。
42/350例患者发生心肌损伤（12.0%，95%置信区间：9.0% - 15.9%）。在多变量分析中（校正比值比[95%置信区间]），既往有缺血性心脏病或中风（5.04[1.40 - 18.08]；P = 0.013）、术中心率>115次/分（2.55[1.06 - 6.12]；P = 0.036）、术中收缩压>210 mmHg（2.38[1.00 - 5.66]；P = 0.049）以及围手术期血红蛋白水平下降（每降低1 g/dL为1.74[1.15 - 2.64]；P = 0.008）与心肌损伤风险增加相关。对于二分法术中血流动力学的累计持续时间，多变量分析显示术中心率>115次/分超过1分钟（2.67[1.08 - 6.97]；P = 0.034）和收缩压>210 mmHg超过1分钟（3.78[1.47 - 9.73]；P = 0.006）与心肌损伤风险增加相关。心肌损伤风险随着术中心动过速和高血压的累计持续时间延长而逐渐增加。
嗜铬细胞瘤腹腔镜肾上腺切除术后心肌损伤发生率较高。已确定的危险因素可能有助于医生识别高危患者，并为术中血流动力学及围手术期血红蛋白管理提供指导。
