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防御性给予酚妥拉明在嗜铬细胞瘤手术中的应用
Application of preadministration phentolamine during the surgry for pheochromocytoma.

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DOI:
作者:
韩传宝,刘存明,周钦海,朱敬明,丁正年
HAN Chuan-bao,LIU Cun-ming ,ZHOU Qin-hai,ZHU Jing-
作者单位:
南京医科大学第一附属医院麻醉科
First Affiliated Hospital, Nanjing Medical University,Nanjing
关键词:
嗜铬细胞瘤; 酚妥拉明；血流动力学；麻醉
Pheochromocytoma;Phentolamine;Haemodynamics;Anesthesia
摘要:
目的 评价嗜铬细胞瘤手术中防御性给予酚妥拉明对维持血流动力学稳定的效果。方法 选择术前诊断并经术后病理证实为嗜铬细胞瘤的患者30例，ASA Ⅱ~Ⅲ级。根据使用降压药种类和方式的不同分成Ⅰ、Ⅱ、Ⅲ 3组，每组10例。Ⅰ组泵注0.01%硝普钠；Ⅱ组泵注0.08%酚妥拉明；Ⅲ组分别于麻醉诱导时和切皮前2min各给予酚妥拉明5mg，分离瘤体前2min给予酚妥拉明10mg。术中根据血压和心率的变化给予乌拉地尔或艾司洛尔。记录麻醉前（T0）、探查肿瘤前（T1）、探查肿瘤时（T2）、肿瘤血管阻断时（T4）和术毕（T4） 5个时点的收缩压(SBP)、HR和CVP以及血管活性药物使用情况。结果 3组患者麻醉前SBP（T0）无统计学差别（P>0.05）；术中肿瘤探查前（T1）均有不同程度的升高；肿瘤探查时（T2），Ⅰ组和Ⅱ组的SBP明显升高（P<0.05），且均高于Ⅲ组（P<0.05）；肿瘤血管阻断后（T3）和术毕时（T4）SBP均明显降低（P<0.05），但组间比较无统计学差异（P>0.05）。3组间的HR和CVP水平在各时点比较均无统计学差异（P>0.05）。Ⅰ组、Ⅱ组乌拉地尔的用量明显多于Ⅲ组（P<0.01）；Ⅱ组酚妥拉明的用量也明显多于Ⅲ组（P<0.01）；3组间艾司洛尔和去甲肾上腺素的用量无明显差别（P>0.05）。结论 在充分术前准备的情况下，针对嗜铬细胞瘤麻醉手术中易引起血流动力学波动的主要操作步骤，防御性给予酚妥拉明可有效维持患者的循环稳定，并可减少其它降压药的使用。
Objective To evaluate the value of preadministration phentolamine during the surgry for pheochromocytoma on the haemodynamics.Methods 30 patients with pheochromocytoma and finally confirmation by pathological examination,ASA class Ⅱ~Ⅲ, underwent adrenalectomy for pheochromocytoma,were divided into three groups with 10 cases in each group. According to the level of blood pressure(BP),0.01% sodium nitroprusside was continuous infusion in group Ⅰ,and continuous infusion with 0.08% phentolamine in group Ⅱ, while in group Ⅲ, 5mg of phentolamine was administrated at anesthesia induction and 2 minutes before the surgery respectively and also administrated 10 mg of phentolamine at 2 minutes before manipulation of the tumor .Given urapidil or esmolol according to the BP and heart rates(HR). Recording the systolic blood pressure(SBP),HR and central venous pressure(CVP) prior to anesthesia(T0),before manipulation of the tumor (T1) ,during dissection the tumor (T2), after ligation of tumor’s venous supply(T3) and when the surgery were over(T4). The dosage of vasoactive agent were also recored. Results SBP was no statistics differences at T0 among the three groups ,but increased at T1 in each group;and increased significantly at T2 in group Ⅰand in group Ⅱ（P<0.05）, meanwhile they were also higher than those in group Ⅲ（P<0.05）,while SBP decreased significantly at T3 and at T4, but they were no statistics differences among the groups（P>0.05）.The levels of HR and CVP were no statistics differences at all of time points among the groups（P>0.05）. The dosage of urapidil in group Ⅰand in group Ⅱ was more than that in group Ⅲ（P<0.01）,while there were no differences about the dosage of both esmolol and noradrenaline（P>0.05）. Compared with the group Ⅲ,dosage of phentolamine was more in group Ⅱ（P<0.01）.Conclusion Preadministration phentolamine can sustain the hemodynamic stability according to the main operating procedure during the surgry for pheochromocytoma under meticulous perioperative preparations ,and also decrease the use of other hypotensive drugs.

 

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