Department of Anesthesiology, Shengjing Hospital of China Medical University, Shenyang, China.
Front Endocrinol (Lausanne). 2024 Apr 8;15:1336128. doi: 10.3389/fendo.2024.1336128. eCollection 2024.
Surgery is the only way to cure pheochromocytoma; however, postoperative hemodynamic instability is one of the main causes of serious complications and even death. This study's findings provide some guidance for improved clinical management.
This study was to investigate the factors leading to postoperative hemodynamic instability in the postoperative pathology indicated pheochromocytoma from May 2016 to May 2022. They were divided into two groups according to whether vasoactive drugs were used for a median number of days or more postoperatively. The factors affecting the postoperative hemodynamics in the perioperative period (preoperative, intraoperative, and postoperative) were then evaluated.
The median number of days requiring vasoactive drug support postoperatively was three in 234 patients, while 118 (50.4%) patients required vasoactive drug support for three days or more postoperatively. The results of the multivariate analysis indicated more preoperative colloid use (odds ratio [OR]=1.834, confidence interval [CI]:1.265-2.659, P=0.001), intraoperative use of vasoactive drug (OR=4.174, CI:1.882-9.258, P<0.001), and more postoperative crystalloid solution input per unit of body weight per day (ml/kg/d) (OR=1.087, CI:1.062-1.112, P<0.001) were risk factors for predicting postoperative hemodynamic instability. The optimal cutoff point of postoperative crystalloid use were 42.37 ml/kg/d.
Hemodynamic instability is a key issue for consideration in the perioperative period of pheochromocytoma. The amount of preoperative colloid use, the need for intraoperative vasoactive drugs, and postoperative crystalloid solution are risk factors for predicting postoperative hemodynamic instability (registration number: ChiCT2300071166).
手术是治愈嗜铬细胞瘤的唯一方法；然而，术后血流动力学不稳定是导致严重并发症甚至死亡的主要原因之一。本研究的结果为改善临床管理提供了一些指导。
本研究旨在探讨 2016 年 5 月至 2022 年 5 月术后病理证实为嗜铬细胞瘤患者术后血流动力学不稳定的相关因素。根据术后使用血管活性药物的中位数天数或更长时间将其分为两组。然后评估围手术期（术前、术中、术后）影响术后血流动力学的因素。
234 例患者术后需要血管活性药物支持的中位数天数为 3 天，而 118 例（50.4%）患者术后需要血管活性药物支持 3 天或更长时间。多变量分析结果表明，术前胶体使用量较多（比值比[OR]=1.834，置信区间[CI]：1.265-2.659，P=0.001）、术中使用血管活性药物（OR=4.174，CI：1.882-9.258，P<0.001）、术后单位体重每日晶体液输入量（ml/kg/d）较多（OR=1.087，CI：1.062-1.112，P<0.001）是预测术后血流动力学不稳定的危险因素。术后晶体液使用量的最佳截断点为 42.37ml/kg/d。
血流动力学不稳定是嗜铬细胞瘤围手术期需要考虑的关键问题。术前胶体使用量、术中血管活性药物的需求以及术后晶体液是预测术后血流动力学不稳定的危险因素（注册号：ChiCT2300071166）。
