儿茶酚胺替代法在嗜铬细胞瘤围手术期应用.DOCVIP

临床医学论文-儿茶酚胺替代法在嗜铬细胞瘤围手术期应用 ??????? 作者：陈斌，周中泉，邢金春，陈实新，刘荣福，王惠强，张开颜???? 　　Management of catecholamine substitution therapy in perioperation of pheochromocytoma (report of 15 cases) 　　　ABSTRACT: Objective? To probe into the application of catecholamine substitution therapy in perioperation of pheochromocytoma. Methods?15 cases of pheochromocytoma were reviewed. All cases received a catecholamine substitution therapy in operation and postoperation, without preoperative hydration. Results?In all the 15 cases, an average of 2950mL fluid was given during surgery, and 400mL blood was transfused. 2500-3200mL fluid was given intravenously after surgery daily with no diet, and 500-1500mL fluid was given after diet. The blood pressure of 9 cases returned normal postoperatively, that of 5 cases was controlled to normal level under hypotensor treatment, and that of 1 case remained unstable with hypotensor. Conclusion?The management of catecholamine substitution therapy in perioperation to replace preoperative hydration can save time for some critical cases, and allow them more opportunities of surgery. It also reduces the cardiopulmonary complications due to the great amount of transfusion perioperatively. In this way, we can improve the success and safety of operation and relieve the economic burden on patients. 　　KEY WORDS: pheochromocytoma; catecholamine substitution therapy; perioperative management 　　摘要：目的? 探讨儿茶酚胺替代法在嗜铬细胞瘤围手术期的应用。方法? 15例嗜铬细胞瘤患者，术前未行扩容准备，而于手术中及手术后应用儿茶酚胺替代法治疗。结果? 本组15例，术中平均输液2950mL，输血或浓缩红细胞约400mL。术后禁食期间输液2500-3500mL，进食后输液500-1500mL。术后9例血压恢复正常，5例继续服用降压药血压可维持正常，1例服药后血压仍有波动。 结论? 对于术前来不及行扩容准备的高危嗜铬细胞瘤患者，于围手术期应用儿茶酚胺替代法，一方面可抓住抢救时间，赢得手术治疗的机会。另一方面，可以避免术前、术中及术后因大量输液而造成的心、肺及血管系统的并发症，而提高手术的成功率和安全性。 　　关键词：嗜铬细胞瘤；儿茶酚胺替代法；围手术期 　　嗜铬细胞瘤临床高风险性疾病。手术治疗是唯一方法，而围手术期的治疗是手术成功的关键。但因部分病人不能耐受冗长的准备时间或围手术期治疗的并发症。因此寻找一种安全的激素替代方法势在必行。我科于1995年3月至2005年6月采用“儿茶酚胺替代法”用于15例嗜铬细胞瘤围手术期治疗，均获得成功，现报告如下。 　　1? 临床资料 　　本组15例，男性11例，女性4例。年龄27-65岁，平均38.6岁。病程6-48月。15例患者均以高血压或高血压危象入院，病变位于左侧肾上腺9例，右侧肾上腺6例。15例中持续