發(fā)布時間：2018-01-04 22:15

  本文關鍵詞：嗜鉻細胞瘤切除術中持續(xù)性低血壓和術后重度高乳酸血癥及乳酸酸中毒的風險因素　出處：《北京協和醫(yī)學院》2017年博士論文　論文類型：學位論文

  更多相關文章： 嗜鉻細胞瘤 高乳酸血癥 乳酸酸中毒 腹腔鏡 腎上腺切除術 嗜鉻細胞瘤 低血壓 兒茶酚胺 腹腔鏡 腎上腺切除術

【摘要】：第一部分 腹腔鏡切除嗜鉻細胞瘤術后重度高乳酸血癥及乳酸酸中毒的風險因素[背景]腹腔鏡嗜鉻細胞瘤切除術后重度高乳酸血癥/乳酸酸中毒是一個常被報道的嚴重并發(fā)癥。本研究旨在調查術后重度高乳酸血癥/乳酸酸中毒的發(fā)生率及探索其風險因素。[方法]研究納入了 2011年3月-2014年6月間在北京協和醫(yī)院行腹腔鏡腎上腺切除術的嗜鉻細胞瘤患者。輕度的高乳酸血癥定義為動脈血乳酸在2.5-5.0 mmol/L之間,且不伴隨酸中毒的證據(pH7.35和或HCO3-20mmol/L)。乳酸酸中毒定義為動脈血乳酸≥5.0mmol/L,伴隨pH7.35和HCO3-20 mmol/L。重度高乳酸血癥定義為動脈血乳酸≥25.0mmol/L,但不伴隨酸中毒證據。采集的數據包括患者人口學資料、病例數據和實驗室檢測。[結果]在145例患者中,59人(40.7%)出現術后動脈血乳酸水平增高。其中,術后輕度高乳酸血癥和重度高乳酸血癥/乳酸酸中毒的發(fā)生率分別為25.5%和15.2%。多因素邏輯回歸的結果表明,體重指數(比值比,1.204;95%可信區(qū)間,1.016-1.426)、術前24h尿腎上腺素水平(比值比,1.012;95%可信區(qū)間,1.002-1.022)和腫瘤大小(比值比,1.571;95%可信區(qū)間,1.102-2.240)是術后重度高乳酸血癥/乳酸酸中毒的獨立風險因素。[結論]腹腔鏡嗜鉻細胞瘤切除術后重度高乳酸血癥/乳酸酸中毒是一個相對常見的并發(fā)癥(15.2%)。體重指數、術前24h尿腎上腺素水平和腫瘤大小是術后重度高乳酸血癥/乳酸酸中毒的獨立預測因子。該研究結果對臨床醫(yī)師快速評估并及時處理術后重度高乳酸血癥/乳酸酸中毒具有重要意義。第二部分腹腔鏡切除嗜鉻細胞瘤術中持續(xù)性低血壓的風險因素[背景]非心臟手術術中低血壓與術后并發(fā)癥密切相關。低血壓在腹腔鏡嗜鉻細胞瘤切除術中非常常見。本研究旨在初步探索術中持續(xù)性低血壓與術后臟器損傷的關系,進而確定術中持續(xù)性低血壓的風險因素。[方法]研究納入了 2012年12月-2015年10月在北京協和醫(yī)院行腹腔鏡腎上腺切除術的嗜鉻細胞瘤患者。持續(xù)性低血壓的定義為患者術中發(fā)生平均動脈壓60 mmHg或需要兒茶酚胺連續(xù)輔助30 min以上。采集的數據包括患者人口學資料、病例數據和實驗室檢測。[結果]在123例患者中,54人(43.9%)發(fā)生了術中持續(xù)性低血壓,需要連續(xù)30min以上的兒茶酚胺輔助。與非持續(xù)性低血壓患者相比,發(fā)生持續(xù)性低血壓的患者術前24h尿腎上腺(p = 0.011)、去甲腎上腺素(p0.001)、多巴胺(p =0.019)水平較高;術后重要臟器損傷的發(fā)生率也比較高(p = 0.038)。多因素邏輯回歸的結果表明,術前24h尿腎上腺素(比值比,1.180;95%可信區(qū)間,1.035-1.345)和多巴胺(比值比,4.375;95%可信區(qū)間,1.207-15.855)水平(參考值上限的倍數)是腹腔鏡嗜鉻細胞瘤切除術中持續(xù)性低血壓的獨立風險因素。[結論]腹腔鏡嗜鉻細胞瘤切除術中持續(xù)性低血壓(43.9%)是一個常見的并發(fā)癥,與術后臟器損傷和住院時間延長有關。術前24 h尿腎上腺素和多巴胺水是術中持續(xù)性低血壓的獨立預測因素。利用這兩個指標,臨床醫(yī)師可以有效評估和及時處理術中發(fā)生持續(xù)性低血壓的嗜鉻細胞瘤患者。
[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.

【學位授予單位】：北京協和醫(yī)學院
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R736.6

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