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目的 探讨嗜铬细胞瘤术前准备的临床体会。 方法 收集 1980～ 2 0 0 2年收治 2 86例嗜铬细胞瘤患者术前准备资料。术前使用酚苄明 2 0 7例 ,使用压宁定 78例 ,1例未用α 肾上腺素能阻滞剂做术前准备 ,急诊手术。用药时间 2～ 9周 ,平均 6周。 2 8%的患者术前加服 β 受体阻滞剂控制心率。 结果 2 5 4例患者血压稳定在 16 .0 / 10 .7kPa(12 0 / 80mmHg)左右 ,无阵发性血压升高 ,心悸 ,多汗等现象 ,体重呈增加趋势 ,心率 80～ 85次 /min ,外周微循环明显改善。肿瘤大小 (直径 3～ 12cm ,平均 5 .2cm)与功能和用药时间长短无明显关系。术前 2周发生高血压危象 32例 ,96 %的患者麻醉诱导和术中挤压肿瘤时血压仍发生波动 ,最高可达 38/ 2 4kPa(2 85 / 180mmHg) ,但较易控制 ,术后血压平稳。 结论 嗜铬细胞瘤术前充分的准备是保证麻醉、术中及术后血压平稳控制、减少心血管并发症和死亡率的关键。
Objective To investigate the clinical experience of preoperative preparation of pheochromocytoma. Methods Preoperative preparation data of 2 86 cases of pheochromocytoma from 1980 to 2002 were collected. Preoperative use of phenylebenzamine 270 cases, the use of ningxin set in 78 cases, 1 without α-adrenergic blockers preoperative preparation, emergency surgery. Medication time 2 to 9 weeks, an average of 6 weeks. 28% of patients preoperative plus beta blockers to control heart rate. Results The blood pressure was stable at 16. 0/10 .7kPa (12 0/80 mmHg) in 25 cases. The incidence of paroxysmal nocturnal hypertension, heart palpitations and hyperhidrosis increased with body weight increasing. The heart rate was 80-85 times / min, peripheral microcirculation improved significantly. Tumor size (diameter 3 ~ 12cm, an average of 5.2cm) and function and duration of medication no significant relationship. Thirty-two cases of hypertensive crisis occurred in 2 weeks before operation, and the blood pressure still fluctuated up to 38/224 kPa (855/80 mmHg) in 96% of the patients under anesthesia induction and intraoperative squeezing of the tumor. However, it was easier to control After the blood pressure steady. Conclusion Preoperative preparation of pheochromocytoma is the key to ensure stable control of anesthesia, intraoperative and postoperative blood pressure and reduce cardiovascular complications and mortality.