【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检查证实为嗜铬细胞瘤的患者30例,美国麻醉医师学会分级Ⅱ或Ⅲ级根据使用降压药种类和方式的不同分为3组,每组10例硝普钠组经微量静脉输液泵注射0.01%硝普钠酚妥拉明1组经微量静脉输液泵注射0.08%酚妥拉明酚妥拉明2组分别于麻醉诱导时和切皮前2min静脉注射酚妥拉明5mg,分离瘤体前2min静脉注射酚妥拉明10mg术中根据血压和心率(HR)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(T3)和术毕(T4)5个时间点的收缩压(SBP)、HR、中心静脉压(CVP)以及血管活性药物使用情况结果 3组间在T0时间点的SBP的差异均无统计学意义(P值均>0.05);在T1时间点有升高趋势,但差异无统计学意义(P值均>0.05);3组在T2时间点的SBP均显著高于同组T0时间点(P值均<0.05),硝普钠组、酚妥拉明1组均显著高于酚妥拉明2组(P值均<0.05);3组在T3、T4时间点的SBP均有低于同组T0时间点的趋势,但差异均无统计学意义(P值均>0.05),3组间差异也均无统计学意义(P值均>0.05)3组间在同时间点的HR和CVP的差异均无统计学意义(P值均>0.05)硝普钠组、酚妥拉明1组的乌拉地尔用量显著多于酚妥拉明2组(P值均<0.01),酚妥拉明1组的酚妥拉明用量显著多于酚妥拉明2组(P<0.01),3组间艾司洛尔和去甲肾上腺素用量的差异均无统计学意义(P值均>0.05)结论在术前准备充分的情况下,在进行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时防御性给予酚妥拉明,可有效维持患者的循环稳定,并可减少其他降压药的用量更多还原

【Abstract】 Objective To evaluate the effect of phentolamine on the haemodynamics during the surgical treatment of pheochromocytoma.Methods Thirty patients with pheochromocytoma confirmed by pathology after surgery,American Society of Anesthesiologists (ASA)Ⅱ-Ⅲ level,were divided into three groups (n=10).0.01% sodium nitroprusside was intravenously infused in group SNP;0.08% phentolamine was intravenously infused in group Ph1.In group Ph2,5 mg phentolamine was administered at anesthesia induction and 2 mins before surgery,and 10 mg phentolamine was injected at 2 mins before manipulation of the tumor.Urapidil or esmolol was given according to the blood pressure (BP) and heart rate (HR).Systolic blood pressure (SBP),HR and central venous pressure (CVP) prior to anesthesia (T0),before surgery (T1),during the dissection of the tumor (T2),after ligation of tumor venous supply (T3) and at the end of the surgery (T4) were all observed.The dosage of vasoactive agent was also recored.Results There was no significant difference in SBP at T0 among the three groups (all P>0.05).SBP was slightly increased at T1,but there was no significant difference among groups (all P>0.05).SBP at T2 was significantly higher than that at T0 in each group (all P<0.05).SBP at T2 in group SNP and group Ph1 was significantly higher than that in group Ph2 (all P<0.05).SBP at T3 and T4 were slightly decreased as compared with T0,but there were no significant differences among the groups (all P>0.05).There was no significant difference in HR and CVP at each time point among the three groups (all P>0.05).Compared with group Ph2,the dosage of urapidil was higher in group SNP and group Ph1 (all P<0.01).The dosage of phentolamine in group Ph1 was significantly higher that in group Ph2 (P<0.01).There were no significant differences in the dosage of both esmolol or noradrenaline among groups (all P>0.05).Conclusion Preadministration of phentolamine can sustain the hemodynamic and decrease the use of other hypotensive drugs during the surgical treatment for pheochromocytoma.(Shanghai Med J,2012,35:1005-1008)更多还原