Russell W J, Metcalfe I R, Tonkin A L, Frewin D B
Department of Anaesthesia and Intensive Care, Royal Adelaide Hospital, South Australia.
Anaesth Intensive Care. 1998 Apr;26(2):196-200. doi: 10.1177/0310057X9802600212.
Although the preoperative use of alpha-receptor antagonist drugs is generally accepted for patients with phaeochromocytoma, evidence on the most appropriate treatment and its timing is scarce. In this retrospective study, the effectiveness of the preoperative preparation of fourteen patients who required surgical excision of a phaeochromocytoma was examined in the light of their operative stability. A simple score was developed of blood pressure stability by scoring the need for additional antihypertensive agents intraoperatively before, and blood pressure support after, tumour removal. A higher score indicated greater instability. Twelve patients received phenoxybenzamine and their stability was superior to the two patients treated with labetalol and with prazosin. There was no correlation between the duration of treatment with phenoxybenzamine and the operative stability (r = 0.18 P = 0.55 Spearman). The five patients who were treated with phenoxybenzamine for longer than 10 days did not have better perioperative blood pressure stability than the five patients who had treatment for less than a week. Predictive factors for intra-operative blood pressure stability were also sought. The degree of postural hypotension after treatment with phenoxybenzamine did not predict operative stability (r = -0.31, P = 0.33 Spearman). However, the peak total catecholamine level found during surgery correlated quite well with more operative instability (r = 0.65, P = 0.031, Spearman), suggesting that patients with phaeochromocytomas with high production of catecholamines are more likely to show cardiovascular instability.
虽然嗜铬细胞瘤患者术前使用α受体拮抗剂药物已被普遍接受，但关于最合适的治疗方法及其时机的证据却很少。在这项回顾性研究中，根据手术稳定性对14例需要手术切除嗜铬细胞瘤患者的术前准备效果进行了检查。通过对术中肿瘤切除前额外使用抗高血压药物的需求以及肿瘤切除后血压支持情况进行评分，制定了一个简单的血压稳定性评分。分数越高表明稳定性越差。12例患者接受了苯苄胺治疗，其稳定性优于另外2例接受拉贝洛尔和哌唑嗪治疗的患者。苯苄胺治疗时间与手术稳定性之间没有相关性（r = 0.18，P = 0.55，Spearman）。接受苯苄胺治疗超过10天的5例患者围手术期血压稳定性并不比治疗时间少于一周的5例患者更好。研究人员还寻找了术中血压稳定性的预测因素。苯苄胺治疗后体位性低血压的程度并不能预测手术稳定性（r = -0.31，P = 0.33，Spearman）。然而，手术期间发现的总儿茶酚胺峰值水平与更高的手术不稳定性相关性相当好（r = 0.65，P = 0.031，Spearman），这表明儿茶酚胺高分泌的嗜铬细胞瘤患者更有可能出现心血管不稳定。
