背景:由于术后低血压(PH)的风险,对于因嗜铬细胞瘤而接受肾上腺切除术的患者,建议进行有创监测.由于高成本和有限的重症监护,我们的目的是确定可能不需要侵入性监测的低PH风险患者.
方法:2012年至2020年期间因嗜铬细胞瘤接受肾上腺切除术的患者的数据由9个英国中心进行回顾性收集,包括病人的人口统计,术中和术后血流动力学参数。分析PH的独立危险因素,并用于制定临床风险评分。
结果:430例患者中有118例(27.4%)出现了PH。关于单变量分析,女性(p=0.007),肿瘤大小(p<0.001),术前儿茶酚胺水平(p<0.001),开放手术(p<0.001)和硬膜外镇痛(p=0.006)被确定为PH的危险因素。在多变量分析中,女性(OR1.85,CI95%,1.09-3.13,p=0.02),术前儿茶酚胺水平(OR:3.11,CI95%,1.74-5.55,p<0.001),开放手术(OR:3.31,CI95%,1.57-6.97,p=0.002)和术前平均动脉血压(OR:0.59,CI95%,0.48-1.02,p=0.08)与PH独立相关,并纳入临床风险评分(AUROC0.69,C统计量0.69)。低和高危患者的PH风险分别为25%和68%,分别。
结论:衍生的风险评分可以对嗜铬细胞瘤肾上腺切除术后有低血压风险的患者进行分层。术后,低风险患者可以在外科病房管理,而高危患者应接受侵入性监测。
Due to the risk of postoperative hypotension (PH), invasive monitoring is recommended for patients who undergo adrenalectomy for phaeochromocytoma. Due to high costs and limited availability of intensive care, our aim was to identify patients at low risk of PH who may not require invasive monitoring.
Data for patients who underwent adrenalectomy for phaeochromocytoma between 2012 and 2020 were retrospectively collected by nine UK centres, including patient demographics, intraoperative and postoperative haemodynamic parameters. Independent risk factors for PH were analysed and used to develop a clinical risk score.
PH developed in 118 of 430 (27.4%) patients. On univariable analysis, female sex (p = 0.007), tumour size (p < 0.001), preoperative catecholamine level (p < 0.001), open surgery (p < 0.001) and epidural analgesia (p = 0.006) were identified as risk factors for PH. On multivariable analysis, female sex (OR 1.85, CI95%, 1.09-3.13, p = 0.02), preoperative catecholamine level (OR: 3.11, CI95%, 1.74-5.55, p < 0.001), open surgery (OR: 3.31, CI95%, 1.57-6.97, p = 0.002) and preoperative mean arterial blood pressure (OR: 0.59, CI95%, 0.48-1.02, p = 0.08) were independently associated with PH, and were incorporated into a clinical risk score (AUROC 0.69, C-statistic 0.69). The risk of PH was 25% and 68% in low and high risk patients, respectively.
The derived risk score allows stratification of patients at risk of postoperative hypotension after adrenalectomy for phaeochromocytoma. Postoperatively, low risk patients may be managed on a surgical ward, whilst high risk patients should undergo invasive monitoring.