不同分泌类型嗜铬细胞瘤的围手术期血流动力学变化

目的 分析分泌不同类型儿茶酚胺的嗜铬细胞瘤围术期血流动力学变化特点.方法 回顾分析1997年1月至2007年7月北京协和医院收治的202例经手术治疗的嗜铬细胞患者的临床资料.按24 h尿儿茶酚胺含量对患者进行分组,分为.肾上腺素高分泌组(高E)和低分泌组(低E),去甲肾上腺素高分泌组(高NE)和低分泌组(低NE)及多巴胺高分泌组(高DA)和低分泌组(低DA),分析肿瘤分泌类型与围术期血流动力学变化特点之间的关系.结果 术前最高收缩压,高E[(201±40)mm Hg]及高NE组[(205±38)mm Hg]显著高于低E[(183±43)mm Hg,P=0.003]及低NE组[(181±43)mm Hg,P=0.000].高E组术中收缩压波动显著高于低E组[(108±39)mm Hg vs(91±33)mm Hg,P=0.001];术后顽固低血压的发生率高NE(23.3%,20/86)及高DA组(32.7%,17/52)显著高于低NE组(2.6%,3/116,P=0.000)及低DA组(4.0%,6/150,P=0.000).结论 肾上腺素高分泌的患者术中易发生较大的血压波动;去甲肾上腺素或多巴胺高分泌的患者术后易发生顽固低血压.

Perioperative hemodynamics in pheochromocytoma secreting different types of catecholamine

OBJECTIVE: To analyze the characteristics of perioperative hemodynamics in pheochromocytoma secreting different types of catecholamine, and to discuss how to improve the hemodynamics. METHODS: The clinical data of 202 patients with pheochromocytoma who had received operation were analyzed. Three classification systems were used to divided the patients: they were, firstly, divided into high and low epinephrine secreting groups (E(high) and E(low)) according to the 24 hours urine catecholamine quantitation; secondly, into high and low norepinephrin secreting groups (NE(high) and NE(low)) according to 24-h urine norepinephrin quantitation; and thirdly, into high and low dopamine secreting groups (DA(high) and DA(low)) according to the 24 hours urine dopamine quantitation. Relationship between the characteristics of perioperative hemodynamics and catecholamine secreting types were analyzed. RESULTS: The highest preoperative systolic blood pressure values of E(high) and NE(high) groups were (201 +/- 40) mm Hg and (205 +/- 38) mm Hg, both significantly higher than those of the E(low) and NE(low) groups [(183 +/- 43) mm Hg, P = 0.003 and (181 +/- 43) mm Hg, P = 0.000]. The range of systolic blood pressure fluctuation during the operation of the E(high) group was 108 +/- 39 mm Hg, significantly larger than that of the E(low) group (91 +/- 33 mm Hg, P = 0.001). The incidence rates of persisting postoperative hypotension of the NE(high) and DA(high) groups were 23.3% (20/86) and 32.7% (17/52) respectively, both higher than those of the NE(low) and DA(low) groups [2.6% (3/116) and 4.0% (6/150) respectively, P = 0.000 and P = 0.000]. CONCLUSION: Different characteristics of perioperative hemodynamics are present in pheochromocytoma secreting different types of catecholamines. Patients with highly epinephrine secreting pheochromocytoma are apt to have larger blood fluctuation during the operation. Patients with highly norepinephrine and dopamine secreting pheochromocytoma are apt to suffer from persisting postoperative hypotension.