嗜铬细胞瘤手术围手术期血液动力学管理的叙述性综述

IF 0.2 Q4 ANESTHESIOLOGY
B. Krishna, D. Khurana, Santvana Kohli, K. Sharma, R. Gandhi
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引用次数: 0

摘要

嗜铬细胞瘤是一种罕见的肾上腺肿瘤,会产生过量的儿茶酚胺,手术切除会因儿茶酚胺的释放而带来术中血液动力学不稳定(HI)的重大风险。这篇综述文章讨论了影响手术切除患者血液动力学不稳定的围手术期因素及其处理。通过使用适当的医学主题标题术语和关键词(如嗜铬细胞瘤、HI和围手术期血液动力学监测)搜索电子数据库Ovid MEDLINE、Embase和Cochrane Library进行文献综述。外科和麻醉技术的进步以及适当的术前医疗优化有助于显著降低死亡率。然而,围手术期HI仍然是治疗嗜铬细胞瘤最大的手术和麻醉挑战。肿瘤越大、激素活性越强的患者在手术中发生极端高血压的风险越高。术前α-阻断、更高剂量的苯氧基苯丙胺和腹腔镜入路可改善色素细胞瘤切除的结果。手术中使用的麻醉技术和药物可能有助于预防HI,但谨慎的术中管理至关重要。围手术期HI可导致手术失血增加、患者发病率增加、重症监护室(ICU)和住院时间延长。因此,涉及外科医生、麻醉师和ICU团队的多学科方法对于确保嗜铬细胞瘤患者的最佳围手术期管理至关重要。术后可能需要加强血液动力学监测,以控制肿瘤切除后出现的低血压。总之,在手术切除嗜铬细胞瘤的过程中,即使采用术前药物治疗,围手术期HI也是一个显著的风险。因此,使用适当的术前医疗优化、手术和麻醉技术以及谨慎的术中管理可以显著改善结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Perioperative hemodynamic management in surgery for phaeochromocytoma: A narrative review
Pheochromocytomas are rare adrenal tumors that produce excessive catecholamines and their surgical removal poses significant risks of intraoperative hemodynamic instability (HI) due to catecholamine release. This review article discusses the perioperative factors that impact hemodynamic lability and its management in patients undergoing surgical removal. A literature review was conducted by searching the electronic databases - Ovid MEDLINE, Embase, and Cochrane Library using appropriate Medical Subject Heading terms and keywords such as phaeochromocytoma, HI, and perioperative hemodynamic monitoring. The advancements in surgical and anesthetic techniques and appropriate preoperative medical optimization have contributed to a significant decrease in mortality rates. However, perioperative HI remains the biggest surgical and anesthetic challenge in treating pheochromocytomas. Patients with larger and more hormonally active tumors are at higher risk for extreme hypertensive episodes during surgery. Preoperative α-blockade, higher phenoxybenzamine doses, and laparoscopic approach improve the outcomes in phaeochromocytoma removal. Anesthetic techniques and drugs used during surgery may help prevent HI, but careful intraoperative management is essential. Perioperative HI can lead to increased surgical blood loss, patient morbidity, and prolonged intensive care unit (ICU) and hospital stay. Therefore, a multidisciplinary approach involving the surgeon, anesthesiologist, and ICU team is essential to ensure optimal perioperative management of patients with pheochromocytoma. Intensive hemodynamic monitoring may be required in the postoperative period to manage hypotension seen after tumor removal. In conclusion, perioperative HI is a significant risk during the surgical removal of pheochromocytomas, even with preoperative pharmacological treatment. Therefore, the use of appropriate preoperative medical optimization, surgical and anesthetic techniques, and careful intraoperative management can significantly improve the outcomes.
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来源期刊
Indian Anaesthetists Forum
Indian Anaesthetists Forum ANESTHESIOLOGY-
自引率
0.00%
发文量
17
审稿时长
6 weeks
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