Steinsapir J, Carr A A, Prisant L M, Bransome E D
Department of Medicine, Medical College of Georgia, Augusta, USA.
Arch Intern Med. 1997 Apr 28;157(8):901-6.
Severe hemodynamic instability may occur during surgery for removal of pheochromocytoma, unless there is preoperative pharmacological treatment.
To evaluate the effects of metyrosine (alpha-methyl-p-tyrosine), a catecholamine synthesis inhibitor, and alpha-blockade with prazosin or phenoxybenzamine on cardiovascular morbidity during surgery for pheochromocytoma.
A retrospective analysis was made of patients followed up at the Medical College of Georgia, Augusta, during 28 years who received metyrosine and prazosin (n = 6), metyrosine and phenoxybenzamine alone (n = 14), phenoxybenzamine alone (n = 6), or no medication (n = 7) during 3 weeks before tumor removal. The percentage of patients not requiring pressors or phentolamine during the intraoperative period as well as the perioperative peak systolic pressures and peak heart rates were estimated in each group.
There was a significant (P < .05) increase in intraoperative peak systolic pressures without preoperative treatment (mean +/- SD, 243 +/- 40 mm Hg) vs metyrosine (mean +/- SD, 168 +/- 27 mm Hg). Ninety-five percent of patients who received metyrosine did not require pressors intraoperatively vs 50% with phenoxybenzamine alone. Eighty-one percent of patients pretreated with metyrosine did not require intraoperative phentolamine vs 33% with phenoxybenzamine alone and 29% without medications. Two patients in the no medication group died as a results of hypertensive crisis.
The combination of alpha-metyrosine and alpha-blockade results in better blood pressure control and less need for use of antihypertensive medication or pressors during surgery, compared with the classical method of single-agent adrenergic blockade. Preoperative treatment with metyrosine along with an alpha-blocker is a useful strategy for decreasing the surgical morbidity in patients with pheochromocytoma and assumes greater importance as long as the availability of phentolamine for intraoperative use is a problem.
除非术前进行药物治疗，否则在切除嗜铬细胞瘤的手术过程中可能会出现严重的血流动力学不稳定。
评估儿茶酚胺合成抑制剂甲酪氨酸以及用哌唑嗪或酚苄明进行α受体阻滞对嗜铬细胞瘤手术期间心血管并发症的影响。
对佐治亚医学院奥古斯塔分校随访28年的患者进行回顾性分析，这些患者在肿瘤切除前3周接受了甲酪氨酸和哌唑嗪（n = 6）、单独使用甲酪氨酸和酚苄明（n = 14）、单独使用酚苄明（n = 6）或未用药（n = 7）。估计每组患者术中不需要使用升压药或酚妥拉明的百分比以及围手术期收缩压峰值和心率峰值。
与甲酪氨酸组（平均±标准差，168±27 mmHg）相比，术前未治疗组术中收缩压峰值显著升高（P <.05）（平均±标准差，243±40 mmHg）。接受甲酪氨酸治疗的患者中有95%术中不需要升压药，而单独使用酚苄明的患者为50%。接受甲酪氨酸预处理的患者中有81%术中不需要酚妥拉明，而单独使用酚苄明的患者为33%，未用药的患者为29%。未用药组有2例患者死于高血压危象。
与经典的单药肾上腺素能阻滞方法相比，甲酪氨酸和α受体阻滞联合使用可更好地控制血压，手术期间对抗高血压药物或升压药的需求更少。术前用甲酪氨酸和α受体阻滞剂治疗是降低嗜铬细胞瘤患者手术并发症的有效策略，并且只要术中使用酚妥拉明存在问题，其重要性就更大。
