嗜铬细胞瘤切除术中持续性低血压和术后重度高乳酸血症及乳酸酸中毒的风险因素

发布时间：2018-01-04 22:15

本文关键词：嗜铬细胞瘤切除术中持续性低血压和术后重度高乳酸血症及乳酸酸中毒的风险因素　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：第一部分腹腔镜切除嗜铬细胞瘤术后重度高乳酸血症及乳酸酸中毒的风险因素[背景]腹腔镜嗜铬细胞瘤切除术后重度高乳酸血症/乳酸酸中毒是一个常被报道的严重并发症。本研究旨在调查术后重度高乳酸血症/乳酸酸中毒的发生率及探索其风险因素。[方法]研究纳入了 2011年3月-2014年6月间在北京协和医院行腹腔镜肾上腺切除术的嗜铬细胞瘤患者。轻度的高乳酸血症定义为动脉血乳酸在2.5-5.0 mmol/L之间,且不伴随酸中毒的证据(pH7.35和或HCO3-20mmol/L)。乳酸酸中毒定义为动脉血乳酸≥5.0mmol/L,伴随pH7.35和HCO3-20 mmol/L。重度高乳酸血症定义为动脉血乳酸≥25.0mmol/L,但不伴随酸中毒证据。采集的数据包括患者人口学资料、病例数据和实验室检测。[结果]在145例患者中,59人(40.7%)出现术后动脉血乳酸水平增高。其中,术后轻度高乳酸血症和重度高乳酸血症/乳酸酸中毒的发生率分别为25.5%和15.2%。多因素逻辑回归的结果表明,体重指数(比值比,1.204;95%可信区间,1.016-1.426)、术前24h尿肾上腺素水平(比值比,1.012;95%可信区间,1.002-1.022)和肿瘤大小(比值比,1.571;95%可信区间,1.102-2.240)是术后重度高乳酸血症/乳酸酸中毒的独立风险因素。[结论]腹腔镜嗜铬细胞瘤切除术后重度高乳酸血症/乳酸酸中毒是一个相对常见的并发症(15.2%)。体重指数、术前24h尿肾上腺素水平和肿瘤大小是术后重度高乳酸血症/乳酸酸中毒的独立预测因子。该研究结果对临床医师快速评估并及时处理术后重度高乳酸血症/乳酸酸中毒具有重要意义。第二部分腹腔镜切除嗜铬细胞瘤术中持续性低血压的风险因素[背景]非心脏手术术中低血压与术后并发症密切相关。低血压在腹腔镜嗜铬细胞瘤切除术中非常常见。本研究旨在初步探索术中持续性低血压与术后脏器损伤的关系,进而确定术中持续性低血压的风险因素。[方法]研究纳入了 2012年12月-2015年10月在北京协和医院行腹腔镜肾上腺切除术的嗜铬细胞瘤患者。持续性低血压的定义为患者术中发生平均动脉压60 mmHg或需要儿茶酚胺连续辅助30 min以上。采集的数据包括患者人口学资料、病例数据和实验室检测。[结果]在123例患者中,54人(43.9%)发生了术中持续性低血压,需要连续30min以上的儿茶酚胺辅助。与非持续性低血压患者相比,发生持续性低血压的患者术前24h尿肾上腺(p = 0.011)、去甲肾上腺素(p0.001)、多巴胺(p =0.019)水平较高;术后重要脏器损伤的发生率也比较高(p = 0.038)。多因素逻辑回归的结果表明,术前24h尿肾上腺素(比值比,1.180;95%可信区间,1.035-1.345)和多巴胺(比值比,4.375;95%可信区间,1.207-15.855)水平(参考值上限的倍数)是腹腔镜嗜铬细胞瘤切除术中持续性低血压的独立风险因素。[结论]腹腔镜嗜铬细胞瘤切除术中持续性低血压(43.9%)是一个常见的并发症,与术后脏器损伤和住院时间延长有关。术前24 h尿肾上腺素和多巴胺水是术中持续性低血压的独立预测因素。利用这两个指标,临床医师可以有效评估和及时处理术中发生持续性低血压的嗜铬细胞瘤患者。
[Abstract]:[background] the risk factors of laparoscopic pheochromocytoma first part laparoscopic resection of pheochromocytoma with severe hyperlactatemia and lactic acidosis after resection of severe hyperlactacidemia / lactic acidosis is a commonly reported serious complications. This study aimed to investigate the postoperative severe hyperlactacidemia / lactic acidosis and the incidence of exploration the risk factors included in the study. Methods: March 2011 -2014 year in June in the Peking Union Medical College Hospital underwent laparoscopic adrenalectomy for pheochromocytoma patients with hyperlactacidemia. The definition of mild arterial blood lactic acid in 2.5-5.0 mmol/L, and is not accompanied by evidence of acidosis (pH7.35 or HCO3-20mmol/L). Lactic acidosis is defined as arterial blood lactic acid was 5.0mmol/L pH7.35 and HCO3-20 mmol/L., with severe hyperlactacidemia defined as arterial blood lactic acid is more than 25.0mmol/L, but not with evidence of acidosis . data collected included patient demographics, clinical data and laboratory test results. In 145 patients, 59 (40.7%) increase of arterial blood lactate levels after operation. Among them, postoperative mild lactic acidosis and severe lactic acidosis / lactic acidosis, the incidence of points that don't logical factors 25.5% and 15.2%. regression results, body mass index (odds ratio, 1.204; 95% Ci, 1.016-1.426), preoperative 24h urinary epinephrine levels (odds ratio, 1.012; 95% Ci, 1.002-1.022) and tumor size (odds ratio, 1.571; 95% Ci, 1.102-2.240) is a severe postoperative hyperlactacidemia / independent risk factors. Conclusion: laparoscopic resection of pheochromocytoma with severe hyperlactacidemia / lactic acidosis lactic acidosis is a relatively common complication (15.2%). The body mass index, preoperative 24h urinary epinephrine level and tumor size was Independent predictors of lactic acidosis after severe hyperlactacidemia /. The research results of clinicians rapid assessment and timely treatment of postoperative severe hyperlactacidemia / lactic acidosis has important significance. The second part laparoscopic resection of pheochromocytoma in risk factors [background] sustained hypotension in non cardiac surgery is closely related with hypotension the postoperative complications in laparoscopic resection of pheochromocytoma. Hypotension is common during the operation. The purpose of this study is to explore the relationship between injury sustained hypotension and postoperative organ surgery, and to determine the risk factors for persistent low blood pressure. Methods in operation into the December 2012 -2015 year in October at the Peking Union Medical College Hospital underwent laparoscopic adrenalectomy for pheochromocytoma patients. The definition of sustained hypotension for patients in the mean arterial pressure of 60 mmHg or need continuous catecholamine More than 30 auxiliary min. The data collected included patient demographics, clinical data and laboratory test results. In 123 patients, 54 (43.9%) had sustained hypotension during operation, need more than 30min. Continuous auxiliary catecholamines compared with non persistent hypotension patients had sustained hypotension in patients the adrenal 24h urine (P = 0.011), norepinephrine (p0.001), dopamine (P =0.019) level is higher; the incidence of postoperative organ damage is relatively high (P = 0.038). The results of multivariate logistic regression showed that the preoperative 24h urinary epinephrine (odds ratio, 1.180; 95% confidence interval 1.035-1.345), and dopamine (odds ratio, 4.375; 95% Ci, 1.207-15.855) level (multiple reference values of laparoscopic excision of pheochromocytoma) is an independent risk of sustained hypotension during operation by laparoscopic excision of pheochromocytoma. Conclusion] In persistent hypotension (43.9%) is a common complication and postoperative organ damage and prolong the time of hospitalization. The preoperative 24 h urinary epinephrine and dopamine is an independent predictor of sustained hypotension during the operation. The use of these two indicators, clinicians can effectively evaluate and timely treatment of persistent hypotension in patients with pheochromocytoma occurred during the operation.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R736.6

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