在患有甲基胺分泌瘤的患者中,β受体阻塞的主要外科手术期间的血液动力学影响
Harald Groeben1, Bente J Nottebaum1, Aarne Feldheiser1
1Department of Anaesthesia, Critical Care Medicine and Pain Therapy, Essen, Germany.
BJA open
|December 27, 2023
概括
在患有甲醇胺产生瘤的患者中,在α受体阻塞之前开始β受体阻塞,在倾向性得分匹配后,血动力学不稳定性没有增加. β阻塞可能表明疾病的严重程度,而不是危险因素.
科学领域:
- 内分泌学 在内分泌学.
- 心血管外科心血管外科
- 麻醉学 麻醉学
背景情况:
- 根据有限的证据,目前的指导方针建议在分类氨基胺产生瘤时,在β受体阻塞之前进行α受体阻塞.
- 临床实践往往涉及在最终诊断叶染色细胞瘤之前启动β阻塞.
- 这项研究调查了在接受和没有先前α受体阻塞治疗的患者的血液动力学变化.
研究的目的:
- 评估在接受贝塔受体阻塞之前或没有阿尔法受体阻塞的,产生甲基胺的瘤的患者的血液动力学变化.
- 确定手术前β阻塞是否是瘤切除期间血液动力学不稳定的独立风险因素.
主要方法:
- 对手术前期血压的前性评估,用于切除染细胞瘤和偏角细胞瘤的患者.
- 主要结局:最大的缩血压 (手术前,手术内和手术后).
- 二次结果:严重高血压峰值和低血压事件的发生率,随后进行倾向性得分匹配分析.
主要成果:
- 与没有β阻塞的患者相比,接受β阻塞的患者在手术前和手术后的缩血压较高.
- 在β阻塞组 (41%对25%) 观察到低血压事件的更高发生率.
- 在倾向得分匹配后,在组之间没有检测到血液动力学参数的显著差异.
结论:
- 隔离的β受体阻塞在患有甲基胺产生瘤的患者中与手术前和手术期间的高血压有关.
- 倾向性得分匹配分析显示没有显著差异,这表明β阻塞是疾病严重程度的标记,而不是不稳定的独立风险因素.
- 这些发现挑战了严格的建议,即在所有情况下,在β阻塞之前启动α阻塞.
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