在嗜铬细胞瘤切除术前省略α-肾上腺素能阻滞剂的递增剂量:实施与现行指南不一致的治疗策略。

IF 7.5 1区 医学 Q1 SURGERY
Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-08-06 DOI:10.1097/SLA.0000000000006493
Isabelle Holscher, Anton F Engelsman, Koen M A Dreijerink, Markus W Hollmann, Tijs J van den Berg, Els J M Nieveen van Dijkum
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引用次数: 0

摘要

目的:本研究描述了在前瞻性患者群体中采用省略术前α-受体阻滞剂量递增(去递增)方案的效果:本研究描述了在前瞻性患者群体中采用省略术前α-受体阻滞剂剂量递增(去递增)方案的效果:嗜铬细胞瘤切除术相关死亡率和发病率的下降常常归功于术前α-受体阻滞剂的引入。目前的治疗方案要求术前α-受体阻滞剂剂量递增和多天住院。然而,目前还缺乏相关证据。此外,最近的数据表明,无论术前α-受体阻滞剂的剂量是否增加,围手术期的安全性都是相同的:方法:对协议执行情况进行单机构评估,包括2015年至2023年间因嗜铬细胞瘤接受肾上腺切除术的患者。术中血流动力学控制通过使用血管活性药物主动调整血压来调节。主要结果是术中高血压,定义为时间加权平均收缩压(TWA-SBP)超过 200 mm Hg。次要结果包括围手术期低血压、术后血压支持需求、住院时间和并发症:在 102 名嗜铬细胞瘤患者中,有 82 人被纳入其中;44 人采用了术前α肾上腺素能降级方案,38 人采用了之前的剂量升级方案。中位数[IQR]TWA-SBP超过200毫米汞柱时,去升级组为0.01[0.0-0.4]毫米汞柱,而剂量升级组为0.0[0.0-0.1]毫米汞柱(P=0.073)。术后持续注射去甲肾上腺素的中位时间分别为 0.3 小时 [0.0-5.5] 和 5.1 小时 [0.0-14.3](P=0.003)。术后出现症状性低血压的患者比例为34.2%对9.1%(P=0.005)。中位住院时间为2.5天[1.9-3.6]对7.1天[6.0-11.9](PC结论:我们的数据表明,采用降级的术前α-受体阻滞方案进行嗜铬细胞瘤肾上腺切除术是安全的,并能缩短住院时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Omitting the Escalating Dosage of Alpha-adrenergic Blockade Before Pheochromocytoma Resection: Implementation of a Treatment Strategy in Discordance With Current Guidelines.

Objective: This study describes the effects of introducing a protocol omitting preoperative α-blockade dose-escalation (de-escalation) in a prospective patient group.

Background: The decline of mortality and morbidity associated with pheochromocytoma resection is frequently attributed to the introduction of preoperative α-blockade. Current protocols require preoperative α-blockade dose-escalation and multiple-day hospital admissions. However, correlating evidence is lacking. Moreover, recent data suggest equal perioperative safety regardless of preoperative α-blockade escalation.

Methods: Single-institution evaluation of protocol implementation, including patients who underwent adrenalectomy for pheochromocytoma between 2015 and 2023. Intraoperative hemodynamic control was regulated by active adjustment of blood pressure using vasoactive agents. The primary outcome was intraoperative hypertension, defined as the time-weighted average of systolic blood pressure (TWA-SBP) above 200 mm Hg. Secondary outcomes included perioperative hypotension, postoperative blood pressure support requirement, hospital stay duration, and complications.

Results: Of 102 pheochromocytoma patients, 82 were included; 44 in the de-escalated preoperative α-adrenergic protocol and 38 following the previous dose-escalation protocol. Median [IQR] TWA-SBP above 200 mm Hg was 0.01 [0.0-0.4] mm Hg in the de-escalated group versus 0.0 [0.0-0.1] mm Hg in the dose-escalated group ( P =0.073). The median duration of postoperative continuous norepinephrine administration was 0.3 hours [0.0-5.5] versus 5.1 hours [0.0-14.3], respectively ( P =0.003). Postoperative symptomatic hypotension occurred in 34.2% versus 9.1% of patients ( P =0.005). Median hospital stay was 2.5 days [1.9-3.6] versus 7.1 days [6.0-11.9] ( P <0.001). No significant differences in complication rates were observed.

Conclusion: Our data suggest that adrenalectomy for pheochromocytoma employing a de-escalated preoperative α-blockade protocol is safe and results in a shorter hospital stay.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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