endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg2013116-22endoserg-6367Research ArticleСтатьиArticlesКатехоламининдуцированная кардиомиопатия у больных с феохромоцитомойCatecholamineinduced cardiomyopathy in patients with pheochromocytomaBeltsevichD G

doktor med. nauk, glavnyy nauchnyy sotrudnik FGBU ENTs

beltsevich@rambler.ruKuznetsovA B

kand. med. nauk, vrach otdeleniya invazivnoy kardiologii FGBU ENTs

-LysenkoM A

kand. med. nauk, vrach otdeleniya neyroendokrino logii FGBU ENTs

-KatsL E

kand. med. nauk, zaveduyushchaya otdeleniem anesteziologii i reanimatsii FGBU ENTs

-GomgjinI S-YukinaM Yu

kand. med. nauk, nauchnyy sotrudnik otdeleniya terapii FGBU ENTs

-20131503201371№1 (2013)1622Copyright © Beltsevich D.G., Kuznetsov A.B., Lysenko M.A., Kats L.E., Gomgjin I.S., Yukina M.Y., 20132013Beltsevich D.G., Kuznetsov A.B., Lysenko M.A., Kats L.E., Gomgjin I.S., Yukina M.Y.Beltsevich D.G., Kuznetsov A.B., Lysenko M.A., Kats L.E., Gomgjin I.S., Yukina M.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/6367

Обсуждаются причины специфического поражения миокарда у пациентов с феохромоцитомой и послеоперационным развитием отека легких, неспецифическими изменениями ЭКГ (катехоламин-индуцированная кардиомиопатия, КИКМП). Материалы. В 2004–2012 гг. из 106 больных дифференциальная диагностика ИБС и КИКМП проводилась у 19 пациентов. 1я группа – 13 больных, в анамнезе (медицинская документация) острый инфаркт миокарда. Диагностика ИБС осуществлялась только после проведения адекватной предоперационной αблокады (по показаниям – дополнительно βблокады). 2я группа – 6 больных с отеком легких (на фоне нормотензии, через 10–70 мин после удаления опухоли) с повышением уровня биомаркеров некроза миокарда и/или ЭКГ-изменениями “ишемического типа” в раннем послеоперационном периоде. Из 19 больных только у одного доказана клинически значимая ишемия миокарда, требующая коррекции. Средние размер опухоли и время операции, степень предоперационной компенсации, суррогатные показатели интраоперационных колебаний АД не имели значимых различий между группами. Средний возраст пациентов 1й группы был значимо старше, чем во 2й (47 против 29). Все больные 2й группы имели преимущественный адреналиновый тип секреции; в 1й группе у 10 больных – норадреналиновый тип секреции, у 2 – смешанный, с преобладанием секреции норадреналина. Вывод. У пациентов с преимущественным адреналиновым типом опухолевой секреции повышен риск возникновения отека легких. Обсуждается возможность применения α-метилпаратирозина в качестве основного средства предоперационной подготовки, а также средств, улучшающих контрактильную способность миокарда.

The article discusses the reasons of specific cardiomyopathy in patients with pheochromocytoma and post operation lungs oedema. 106 pheochromocytoma patients were operated between 2004 and 2012 in Endocrine Research Center, 19 of them were investigated for ischemia myocardial changes. This cohort is divided into 2 groups: the first one includes 13 patients with preoperation notes of acute myocardial infarc tion (non Q developing), the second one consists of 6 patients with lung oedema in early postoperation time. All patients were operated after adequate preparation with α and βblockers. After clinical examina tion only 1 patient had conclusive ischemia, which required correction. Among reasons influencing a lung oedema (tumour size, manipulation time, age, sex, fluctuations of blood pressure) only the epinephrine type of tumor secretion was significant. Conclusion. Patients with adrenaline type secretion of pheochromocytoma have a higher risk of a lung oedema. The level of risk doesn’t depend on myocardial ischemia. Discussion. Possibility and necessity of administration of tyrozinkynase inhibitor (αmetylparatyrozine) or sensitisers of myocardial contraction (levosemindan) as the main means for preparation to a pheochromo cytoma surgery in epinephrinetype patients must be considered.

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The authors declare that there are no conflicts of interest present.