一例嗜铬细胞瘤切除术中顽固性低血压的处理

Management of Refractory Hypotension during a Case of Chromaffinoma Resection

摘要: 患者，女，67岁，体重56 kg，因高血压病史7年，伴阵发性心悸、头晕、头痛，加重2个月入院。术前诊断：1、左侧腹膜后肿瘤：异位嗜铬细胞瘤？2、高血压病3级很高危。术前降压扩容后，拟在全麻下行腹腔镜下左侧腹膜后肿瘤切除术。术中瘤体切除前循环波动较小，并充分扩容，瘤体切除后患者出现顽固性低血压，经大剂量血管活性药以及快速大量补液升压效果均不明显，后给予补充糖皮质激素、亚甲蓝、血管加压素、调整体位、低温，以及减浅麻醉调整内环境的稳定，维持重要脏器的灌注，血压回升。术后患者预后良好。

Abstract: A female patient, 67 years old, weighing 56 kg, was admitted to hospital with a 7-year history of hypertension, accompanied by paroxysmal heart palpitations, dizziness, and headache, which worsened for 2 months. Preoperative diagnosis: 1. Left retroperitoneal tumor: ectopic pheochromocytoma? 2. Hypertension level 3 is very high risk. After preoperative hypotension and volume expansion, laparoscopic left retroperitoneal tumor resection was planned under general anesthesia. During the operation, the circulation fluctuation before tumor resection was small, and the volume was fully expanded. After tumor resection, the patient had intractable hypotension, and the effect of high-dose vasoactive drugs and rapid and massive fluid infusion was not obvious. After that, the patients were given glucocorticoid, methylene blue, vasopressin, posture adjustment, hypothermia, and shallow anesthesia to adjust the stability of the internal environment, maintain the perfusion of important organs, and the blood pressure rose. The prognosis was good.