Retrospective Analysis Of Risk Factors Of Intraoperative Blood Pressure Fluctuation In Patients With Pheochromocytoma

Objective:To retrospectively analyze the risk factors of blood pressure fluctuation in patients with pheochromocytoma,and to provide reference for the development of blood pressure management program during pheochromocytoma anesthesia.Methods:The clinical data of patients with elective laparoscopic pheochromocytoma resection were collected from June 2014 to June 2016 by using the Anesthesia information system of the General Hospital of Nanjing Military Region.And the number of episodes of intraoperative hypertension(intraoperative blood pressure>140/90 mmHg or systolic blood pressure exceeding baseline 20%)and/or hypotension(intraoperative blood pressure<90/60 mmHg or systolic blood pressure reduction exceeding baseline 20%)is chosen as a measure of intraoperative hemodynamic instability.The gender,age,body weight,preoperative plasma NE and E concentration,tumor diameter,and surgical procedure were analyzed whether correlated with intraoperative hemodynamic instability by using two correlation statistics testing method.Results:1.In this group,the blood pressure of 17 patients was controlled by phentolamine purely 1 week before operation,and that of 6 patients was controlled by phentolamine purely 2 weeks before operation,and 9 patients were treated with phentolamine and Amlodipine to control blood pressure.All the blood pressures were controlled below 140/90mmHg to achieve elective surgery standards.2.There were 12 cases of 1 time hypertension in operation,no antihypertensive drugs were used during surgery.There were 10 cases of 2 times hypertension in operation,simply use sodium nitroprusside pump to control and within 10min BP slow down to<140/90mm Hg(sodium nitroprusside average pump intake of 2.5vg/kg/min).There were 6 patients with more than 3 times hypertension and after 10min continuous injection of sodium nitroprusside pump whose blood pressures were still higher than<140/90mm Hg,combined with pressure Ningding 10mg fraction intravenous,BP<140/90mm Hg.There were 8 cases of hypotension in the operation and all occurred after pheochromocytoma resection,of which the lowest pressure was 76/50mmHg,and 3 cases of which returned normal after intravenous injection of ephedrine 10mg and to speed up the infusion,the remaining 5 cases'systolic blood pressure can be maintained at 90 10mmHg after Adrenaline O.lmg/times intravenous.3.There was no significant correlation between the number of postoperative hypertension and the sex,age,body weight,ASA grade,preoperative blood E concentration and tumor size(P>0.050).But there was a significant positive correlation between the number of postoperative hypertension and NE concentration(r = 0.693,P = 0.000).There was no significant correlation between the number of intraoperative hypotension and the sex,age,body weight,ASA grade,preoperative plasma NE concentration,preoperative blood E concentration and CT tumor diameter(P>0.050).Conclusion:Adequate preoperative preparation and reasonable anesthetic management are key to hemodynamic stability in pheochromocytoma surgery.Preoperative plasma NE concentration is a risk factor for the risk of hypertension in patients undergoing pheochromocytoma surgery.