颈静脉孔区副神经节瘤患者围术期心率血压的变化特征
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摘要
目的研究颈静脉孔区副神经节瘤切除术后患者心率和血压的变化特征。方法回顾性分析2015年7月至2019年3月收治并进行手术治疗的颈静脉孔区副节瘤患者18例。所有患者均行手术治疗,比较患者术前1周(基础值)与术后短期(1天、3天、7天)心率血压的变化。结果颈静脉孔区副节瘤患者术后1天、3天、7天心率(heart rate, HR)均增快,差异有统计学意义(P<0.01)。低剂量的β受体阻滞剂控制术后心率效果欠佳。住院期间心率恢复正常最长需21天。其它侧颅底肿瘤患者术后短期心率变化无统计学意义。颈静脉孔区副节瘤患者术后血压变化较其它侧颅底肿瘤无特异性。结论颈静脉孔区副节瘤切除后患者围术期心率有一定程度增快,此现象有一定的临床意义。
Objective To report effects of jugulare foramen paraganglioma resection on heart rate and blood pressure in the perioperative period. Methods Clinical data from 18 patients undergoing jugulare foramen paraganglioma resection from July 2015 to March 2019 was reviewed. Heart rate(HR) and blood pressure were recorded continuously during perioperative period. Results Heart rate increased for 1-7 days after operation(P<0.01). Low dose β-receptor blockers were not effective in controlling postoperative heart rate. In contrast, there were no significant changes in perioperative heart rate after other lateral skull base surgeries. It could take as long as 21 days for HR to fall down. There was no specific variation of blood pressure in these patients compared to other lateral skull base surgery patients. Conclusion Jugulare foramen paraganglioma resection is associated with postoperative heart rate increase. This finding is significant for perioperative management
Objective To report effects of jugulare foramen paraganglioma resection on heart rate and blood pressure in the perioperative period. Methods Clinical data from 18 patients undergoing jugulare foramen paraganglioma resection from July 2015 to March 2019 was reviewed. Heart rate(HR) and blood pressure were recorded continuously during perioperative period. Results Heart rate increased for 1-7 days after operation(P<0.01). Low dose β-receptor blockers were not effective in controlling postoperative heart rate. In contrast, there were no significant changes in perioperative heart rate after other lateral skull base surgeries. It could take as long as 21 days for HR to fall down. There was no specific variation of blood pressure in these patients compared to other lateral skull base surgery patients. Conclusion Jugulare foramen paraganglioma resection is associated with postoperative heart rate increase. This finding is significant for perioperative management
引文
1 J.W.Lenders,Q.Y.Duh,G.Eisenhofer,et al.Endocrine,Pheochromocytoma and paraganglioma:an endocrine society clinical practice guideline[J].J Clin Endocrinol Metab,2014,99(6):1915-1942.
2 M.D.Williams.Paragangliomas of the Head and Neck:An Overview from Diagnosis to Genetics[J].Head Neck Pathol,2017,11(3):278-287.
3申卫东,李竹梅,戴朴,等搏动性耳鸣伴听力下降、面瘫、颈部包块[J].中华耳科学杂志,2016,14(3):6.Shen WD,Li ZM,Dai P,et al.Pulsating tinnitus with hearing loss,facial paralysis,and neck mass[J].Chinese journal of Otology,2016,14(3):6.
4 G.L.Bakris,R.R.Townsend,J.M.Flack,et al.12-month blood pressure results of catheter-based renal artery denervation for resistant hypertension:the SYMPLICITY HTN-3 trial[J].J Am Coll Cardiol,2015,65(13):1314-1321.
5 S.Oparil,R.E.Schmieder.New approaches in the treatment of hypertension[J].Circ Res,2015,116(6):1074-1095.
6 Y.Lu,X.Ma,R.Sabharwal,et al.The ion channel ASIC2 is required for baroreceptor and autonomic control of the circulation[J].Neuron,2009,64(6):885-897.
7 M.Fudim,K.L.Groom,C.L.Laffer,J.L,et al.Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients[J].J Am Soc Hypertens,2015,9(6):435-442.
8刘端,邵江,刘暴,等,颈动脉体瘤切除术后原发性高血压患者血压的变化[J].中华普通外科杂志,2017,32(9):754-757.Liu D,Shao J,Liu B,et al.Influence of carotid body tumor resection on the blood pressure in essential hypertensive patients[J].Chin J Gen Surg,2017,32(9):754-757.
9 S.E.Rha,J.Y.Byun,S.E.Jung,et al.Neurogenic tumors in the abdomen:tumor types and imaging characteristics[J].Radiographics,2013,23(1):29-43.
10 M.Kitahara,T.Mori,H.Seki,et al.Malignant paraganglioma presenting as Cushing syndrome with virilism in childhood.Production of cortisol,androgens,and adrenocorticotrophic hormone by the tumor[J].Cancer,1993,72(11):3340-3345.
11 F.Otsuka,T.Miyoshi,K.Murakami,et al.An extra-adrenal abdominal pheochromocytoma causing ectopic ACTH syndrome[J].Am J Hypertens,2005,18(10):1364-1368.
12 G.Sangster,D.Do,C.Previgliano,et al.Primary retroperitoneal paraganglioma simulating a pancreatic mass:a case report and review of the literature[J].HPB Surg,2010,2010:645728.
13 H.S.Willenberg,J.Feldkamp,R.Lehmann,et al.A case of catecholamine and glucocorticoid excess syndrome due to a corticotropin-secreting paraganglioma[J].Annals of the New York Academy of Sciences,2006,1073:52-58.
14 K.M.Dahir,A.Gonzalez,M.P.Revelo,et al.Ectopic adrenocorticotropic hormone hypersecretion due to a primary pulmonary paraganglioma[J].Endocrine practice:official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists,2004,10(5):424-428.
15 F.Flohr,H.Geddert.Images in clinical medicine.Ectopic Cushing's syndrome[J].N Engl J Med,2011,365(25):e46.
16 T.L.Johnson,B.Shapiro,W.H.Beierwaltes,et al.Cardiac paragangliomas.A clinicopathologic and immunohistochemical study of four cases[J].Am J Surg Pathol,1985,9(11):827-834.
17 M.A.Palau,M.J.Merino,M.Quezado.Corticotropin-producing pulmonary gangliocytic paraganglioma associated with Cushing's syndrome[J].Hum Pathol,2006,37(5):623-626.
18 H.K.Park,C.M.Park,K.H.Ko,et al.A case of Cushing's syndrome in ACTH-secreting mediastinal paraganglioma[J].Korean J Intern Med,2000,15(2):142-146.
19 S.J.Reddy,G.Purushottam,K.Pandurangarao,et al.Para aortic ganglioneuroma presenting as Cushing's syndrome[J].Indian journal of urology:IJU:journal of the Urological Society of India,2007,23(4):471-473.
20 B.Lieberum,C.Jaspers,R.Munzenmaier.ACTH-producing paraganglioma of the paranasal sinuses[J].HNO,2003,51(4):328-331.
21 F.Serra,S.Duarte,S.Abreu,et al.Cushing's syndrome due to ectopic ACTH production by a nasal paraganglioma[J].Endocrinology,diabetes&metabolism case reports,2013,2013:130038.
22 T.Thomas,S.Zender,C.Terkamp,et al.Hypercortisolaemia due to ectopic adrenocorticotropic hormone secretion by a nasal paraganglioma:a case report and review of the literature[J].BMCRes Notes,2013,6:331.
23 M.Bohm,J.C.Reil,P.Deedwania,et al.Resting heart rate:risk indicator and emerging risk factor in cardiovascular disease[J].Am J Med,2015,128(3):219-228.
24 F.Custodis,U.Roggenbuck,N.Lehmann,et al.Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population[J].Clin Res Cardiol,2016,105(7):601-612.
2 M.D.Williams.Paragangliomas of the Head and Neck:An Overview from Diagnosis to Genetics[J].Head Neck Pathol,2017,11(3):278-287.
3申卫东,李竹梅,戴朴,等搏动性耳鸣伴听力下降、面瘫、颈部包块[J].中华耳科学杂志,2016,14(3):6.Shen WD,Li ZM,Dai P,et al.Pulsating tinnitus with hearing loss,facial paralysis,and neck mass[J].Chinese journal of Otology,2016,14(3):6.
4 G.L.Bakris,R.R.Townsend,J.M.Flack,et al.12-month blood pressure results of catheter-based renal artery denervation for resistant hypertension:the SYMPLICITY HTN-3 trial[J].J Am Coll Cardiol,2015,65(13):1314-1321.
5 S.Oparil,R.E.Schmieder.New approaches in the treatment of hypertension[J].Circ Res,2015,116(6):1074-1095.
6 Y.Lu,X.Ma,R.Sabharwal,et al.The ion channel ASIC2 is required for baroreceptor and autonomic control of the circulation[J].Neuron,2009,64(6):885-897.
7 M.Fudim,K.L.Groom,C.L.Laffer,J.L,et al.Effects of carotid body tumor resection on the blood pressure of essential hypertensive patients[J].J Am Soc Hypertens,2015,9(6):435-442.
8刘端,邵江,刘暴,等,颈动脉体瘤切除术后原发性高血压患者血压的变化[J].中华普通外科杂志,2017,32(9):754-757.Liu D,Shao J,Liu B,et al.Influence of carotid body tumor resection on the blood pressure in essential hypertensive patients[J].Chin J Gen Surg,2017,32(9):754-757.
9 S.E.Rha,J.Y.Byun,S.E.Jung,et al.Neurogenic tumors in the abdomen:tumor types and imaging characteristics[J].Radiographics,2013,23(1):29-43.
10 M.Kitahara,T.Mori,H.Seki,et al.Malignant paraganglioma presenting as Cushing syndrome with virilism in childhood.Production of cortisol,androgens,and adrenocorticotrophic hormone by the tumor[J].Cancer,1993,72(11):3340-3345.
11 F.Otsuka,T.Miyoshi,K.Murakami,et al.An extra-adrenal abdominal pheochromocytoma causing ectopic ACTH syndrome[J].Am J Hypertens,2005,18(10):1364-1368.
12 G.Sangster,D.Do,C.Previgliano,et al.Primary retroperitoneal paraganglioma simulating a pancreatic mass:a case report and review of the literature[J].HPB Surg,2010,2010:645728.
13 H.S.Willenberg,J.Feldkamp,R.Lehmann,et al.A case of catecholamine and glucocorticoid excess syndrome due to a corticotropin-secreting paraganglioma[J].Annals of the New York Academy of Sciences,2006,1073:52-58.
14 K.M.Dahir,A.Gonzalez,M.P.Revelo,et al.Ectopic adrenocorticotropic hormone hypersecretion due to a primary pulmonary paraganglioma[J].Endocrine practice:official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists,2004,10(5):424-428.
15 F.Flohr,H.Geddert.Images in clinical medicine.Ectopic Cushing's syndrome[J].N Engl J Med,2011,365(25):e46.
16 T.L.Johnson,B.Shapiro,W.H.Beierwaltes,et al.Cardiac paragangliomas.A clinicopathologic and immunohistochemical study of four cases[J].Am J Surg Pathol,1985,9(11):827-834.
17 M.A.Palau,M.J.Merino,M.Quezado.Corticotropin-producing pulmonary gangliocytic paraganglioma associated with Cushing's syndrome[J].Hum Pathol,2006,37(5):623-626.
18 H.K.Park,C.M.Park,K.H.Ko,et al.A case of Cushing's syndrome in ACTH-secreting mediastinal paraganglioma[J].Korean J Intern Med,2000,15(2):142-146.
19 S.J.Reddy,G.Purushottam,K.Pandurangarao,et al.Para aortic ganglioneuroma presenting as Cushing's syndrome[J].Indian journal of urology:IJU:journal of the Urological Society of India,2007,23(4):471-473.
20 B.Lieberum,C.Jaspers,R.Munzenmaier.ACTH-producing paraganglioma of the paranasal sinuses[J].HNO,2003,51(4):328-331.
21 F.Serra,S.Duarte,S.Abreu,et al.Cushing's syndrome due to ectopic ACTH production by a nasal paraganglioma[J].Endocrinology,diabetes&metabolism case reports,2013,2013:130038.
22 T.Thomas,S.Zender,C.Terkamp,et al.Hypercortisolaemia due to ectopic adrenocorticotropic hormone secretion by a nasal paraganglioma:a case report and review of the literature[J].BMCRes Notes,2013,6:331.
23 M.Bohm,J.C.Reil,P.Deedwania,et al.Resting heart rate:risk indicator and emerging risk factor in cardiovascular disease[J].Am J Med,2015,128(3):219-228.
24 F.Custodis,U.Roggenbuck,N.Lehmann,et al.Resting heart rate is an independent predictor of all-cause mortality in the middle aged general population[J].Clin Res Cardiol,2016,105(7):601-612.