协和医学杂志

2019, v.10(04) 353-357

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嗜铬细胞瘤/副神经节瘤术前儿茶酚胺心肌病的药物治疗方案
Preoperative Medicine Treatment for Catecholamine-induced Cardiomyopathy in Patients with Pheochromocytoma/Paraganglioma

樊华;张玉石;纪志刚;张学斌;李汉忠;
FAN Hua;ZHANG Yu-shi;JI Zhi-gang;ZHANG Xue-bin;LI Han-zhong;Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

摘要(Abstract):

目的总结嗜铬细胞瘤/副神经节瘤患者术前儿茶酚胺心肌病的药物调整方案,以期保证手术安全性。方法回顾性收集整理2007年1月至2019年1月在北京协和医院泌尿外科接受手术治疗的嗜铬细胞瘤/副神经节瘤伴儿茶酚胺心肌病患者的临床资料,包括临床表现、超声心动图检查结果、儿茶酚胺心肌病治疗方案及治疗前后血、尿儿茶酚胺及代谢物、心功能的改变,并分析去甲肾上腺素水平与儿茶酚胺心肌病严重程度的相关性。正态分布的定量资料结果以均数±标准差表示,组间比较采用配对t检验,P<0. 05为差异有统计学意义。结果 17例患者符合入选和排除标准,轻至中度心功能不全,左心室射血分数(left ventricular ejection fraction,LVEF)平均为(42. 58±7. 35)%,经药物治疗后所有患者心功能得到改善,LVEF较治疗前显著提高至(56. 0±7. 09)%(t=0. 507,P=0. 038)。高去甲肾上腺素组及低去甲肾上腺素组的LVEF分别为(43. 11±5. 79)%和(42. 0±9. 19)%(t=0. 015,P=0. 973),药物治疗后两组LVEF分别为(55. 2±5. 21)%和(56. 87±9. 07)%(t=-0. 145,P=0. 732),差异均无统计学意义。结论嗜铬细胞瘤/副神经节瘤伴儿茶酚胺心肌病患者经药物治疗可有效改善心功能,去甲肾上腺素水平与儿茶酚胺心肌病严重程度无关。
Objective The aim of this study was to discuss the preoperative medicine treatment and adjustment for catecholamine-induced cardiomyopathy in patients with pheochromocytoma/paraganglioma to ensure the safety of operation. Methods The clinical information of patients with catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma who underwent surgery in the Department of Urology at Peking Union Medical College Hospital from January 2007 to January 2019 was retrospectively collected and reviewed,including the clinical features,echocardiographic results,therapeutic strategies for catecholamine-induced cardiomyopathy,urinary catecholamine and its metabolites,and the cardiac function. The correlation between norepinephrine level and severity of catecholamine-induced cardiomyopathy was evaluated. Normal distribution quantitative data were expressed by mean±SD and analyzed by t test. The difference was statistically significant with P<0. 05. Results Seventeen patients meeting the inclusive and exclusive criteria were enrolled in this study.All patients had mild to moderate heart failure. The left ventricular ejection fraction( LVEF) before and after the medication was( 42. 58±7. 35) % and( 56. 0±7. 09) % respectively( t = 0. 507,P = 0. 038). The LVEF of patients with catecholamine-induced cardiomyopathy in the high norepinephrine group and low norepinephrine group were( 43. 11 ± 5. 79) % and( 42. 0 ± 9. 19) %( t = 0. 015,P = 0. 973),and after treatment,( 55. 2 ±5. 21) % and( 56. 87±9. 07) %( t =-0. 145,P = 0. 732) respectively. Conclusions Medicine might improve the cardiac function of patients with catecholamine-induced cardiomyopathy in pheochromocytoma/paraganglioma.Norepinephrine level is not correlated with the severity of catecholamine-induced cardiomyopathy.

关键词(KeyWords): 嗜铬细胞瘤;副神经节瘤;儿茶酚胺心肌病;治疗
pheochromocytoma;paraganglioma;catecholamine-induced cardiomyopathy;treatment

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作者(Author): 樊华;张玉石;纪志刚;张学斌;李汉忠;
FAN Hua;ZHANG Yu-shi;JI Zhi-gang;ZHANG Xue-bin;LI Han-zhong;Department of Urology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences &Peking Union Medical College;

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