肾上腺嗜铬细胞瘤术中血NMN和MN的动态变化

目的研究嗜铬细胞瘤切除手术中,患者间羟去甲肾上腺素(NMN)和间羟肾上腺素(MN)的动态变化规律。方法23例肾上腺肿瘤患者(肾上腺嗜铬细胞瘤14例和非肾上腺嗜铬细胞瘤9例),分别于麻醉诱导后、开始切皮时、探查肿瘤时、切除肿瘤时、麻醉结束时的5个时间点进行采血,利用高效液相色谱法测定血液样本中NMN和MN的水平。结果肾上腺嗜铬细胞瘤患者的NMN水平,在手术中各时间点有明显统计学差异(P<0.05),而MN无明显差异(P>0.05);非肾上腺嗜铬细胞瘤患者的NMN和MN水平,在手术期间各时间点均无统计学差异(P>0.05)。结论肾上腺嗜铬细胞手术中,患者血NMN在不同时间点有明显变化,而MN相对稳定。提示术中麻醉诱导和探查是手术成功的关键,MN是诊断肾上腺嗜铬细胞瘤较为稳定的监测指标。

Changes of Plasma NMN and MN During the Operation of Pheochromocytoma

Objective To study the changes of plasma normetanephrine(NMN) and metanephrine(MN) during the resection of adrenal pheochromocytoma. Methods Fourteen patients with adrenal pheocromocytoma and 9 patients with adrenal cortex tumor were recruited in our study. Blood samples were obtained at these time points: after anesthesia induction,the beginning of incision of skin, when exploring the tumor,resection of the tumor, and the end of anesthesia. The NMN and MN were determined by high performance liquid chromatogram (HPLC). Results NMN were obviously different among 5 time points in the patients with adrenal pheocromocytoma (P<0.05), but MN were of no statistical significance (P>0.05). No significant difference was found between NMN and MN in the patients with adrenal cortex tumor. Conclusion NMN has markedly changed during the resection of adrenal pheochromocytoma, while MN has been relatively stable. The anesthesia induction and exploring of the tumor are the key of a successful operation. MN is the stable index in the diagnosis of adrenal pheochromocytoma.