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通过隐性类分析,重新定义色细胞瘤手术中的血液动力学不稳定性

Laura Alberici¹, Claudio Ricci^1,2, Valentina Vicennati^2,3

¹Pancreatic and Endocrine Surgical Unit, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, 40138 Bologna, Italy.

European journal of endocrinology

|September 29, 2025

概括

这项研究使用平均动脉压 (MAP) 开发了在染细胞瘤手术期间血液动力学不稳定性 (HDI) 的客观分类. 这种数据驱动的方法可以识别高风险和低风险的患者群体,以改善外科手术管理.

科学领域:

麻醉学和重症监护医学
手术瘤学手术瘤学
心血管生理学心血管生理学

背景情况:

染细胞瘤切除期间的血液动力学不稳定性 (HDI) 是一个重大的麻醉学挑战.
目前对HDI的定义往往是任意的,阻碍了有效的风险分层和可比性.
需要一个客观的,数据驱动的分类来标准化评估和管理.

研究的目的:

开发和验证一个客观的,数据驱动的分类系统,用于手术内血动力学不稳定性 (HDI).
为了识别不同的患者风险群体进行染细胞瘤手术切除.
为了改善这种复杂的手术的麻醉学管理和风险分层.

主要方法:

收集了来自92名患者的5个手术内时间点的血液动力学变量 (SBP,DBP,HR,MAP).
使用隐性类分析 (LCA) 将患者分为低风险 (l-HDI) 和高风险 (h-HDI) 组.
通过使用不同的血液动力学变量组合,评估了四种LCA模型,通过AIC和BIC选择最佳模型.

主要成果:

仅使用手术内平均动脉压 (MAP) 的LCA模型提供了最好的分类 (AIC: 3783; BIC: 3824).
确定了两个不同的类别:高风险的HDI (34.8%) 和低风险的HDI (65.2%).
在关键手术阶段观察到群体之间的显著MAP差异;患者年龄和症状呈现是HDI的强有力的预测因素.

结论:

建议在染细胞瘤手术中进行可复制和客观的手术内HDI分类.
该分类是基于从隐性类分析 (LCA) 获得的平均动脉压 (MAP).
这种客观的分类有助于更好的风险分层和血液动力学不稳定的管理.

关键词:

上腺切除术 (adrenalectomy) 是一种血液动力学不稳定性这种高血压,高血压.叶染色细胞瘤 ( pheochromocytoma) 是一种致血性细胞瘤.

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