Objective To investigate the effect of preoperative doxazosin preparation time on intraoperative hemodynamics of patients with phaeochromocytoma or paraganglioma under accurate anesthesia management mode.Methods A retrospective cohort study was performed in 232 patients who underwent elective phaeochromocytoma or paraganglioma resection at Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2021.There were 199 patients with phaeochromocytoma and 33 patients with paraganglioma.According to preoperative doxazosin preparation time(T,days),the patients were divided into 4 groups:T＜14 group,14≤ T≤28 group,28＜T≤42 group,and T＞42 group.The incidence of intraoperative hemodynamic instability(HI)was compared among the four groups.The maximum,minimum,and fluctuation of intraoperative SBP,DBP,MAP and heart rate,as well as intraoperative hypotension and the use of vasoactive agents and cardiotonic agents were observed.The Clavien-Dindo scoring was used to evaluate early prognosis and the length of postoperative hospital stay was recorded.Results HI occurred in 98 patients.Univariate analysis showed that the proportions of patients with ASA Ⅲ and diabetes mellitus and preoperative levels of serum metanephrine and normetanephrine in HI group were significantly higher than those in non-HI group(all P＜0.05).The variables with P＜0.25 in univariate analysis and preoperative doxazosin preparation time were included in multivariate logistic regression analysis,and the result showed that high ASA level and diabetes mellitus were risk factors for intraoperative HI(both P＜0.05),but preoperative doxazosin preparation time was not an independent risk factor for intraoperative HI in patients with phaeochromocytoma or paraganglioma(P＞0.05).The proportions of patients with a history of hypertension in the 14≤T≤28 group and T＞42 group were significantly higher than those in the T＜14 group(all P＜0.05/6).There were no statistically significant differences in the incidence of intraoperative HI,hemodynamic indexes,anesthesia time,operating time,the use of cardiotonic agents,the volume of positive fluid balance,the proportion of different surgical methods,or the usage of vasoactive agents among groups(all P＞0.05/6).The proportion of patients with Clavien-Dindo grade 2 in the 14≤ T≤28 group and T＞42 group was significantly higher than that in the T＜14 group(both P＜0.05/6).There were no statistically significant differences in the proportion of patients with Clavien-Dindo grade 1,3,4 after surgery or length of postoperative hospital stay among groups(all P＞0.05/6).No in-hospital deaths occurred.Conclusion Under the accurate anesthesia management mode,preoperative doxazosin preparation time has no significant effect on intraoperative hemodynamics in patients with phaeochromocytoma or paraganglioma.The maintenance of an ideal anesthesia state,comprehensive hemodynamic monitoring,goal-oriented liquid management strategies,and individual rapid and short-term use of vasoactive agents are key for maintaining stable intraoperative hemodynamics.
维普
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