目的 观察腹腔镜肾上腺切除术对肾上腺性高血压患者血压的影响,探讨术后高血压的相关影响因素,以提高肾上腺性高血压的临床治疗效果。方法 回顾性分析2021年1月—2023年12月期间筛查出的100例肾上腺性高血压并接受腹腔镜肾上腺切除术患者的临床数据,按照术后血压情况分为术后血压正常组（n=50）与高血压组（n=50）。所有患者均接受了肾上腺CT检查、原发性醛固酮增多症（PA）筛查试验和肾上腺静脉采血（AVS）及术后半年的随访,收集患者的一般资料,术前、术后的血压、降压药物使用情况、血钾水平、醛固酮水平等,分析术后血压正常组和高血压组的差异。结果 高血压组患者多为男性、有吸烟史、有饮酒史、体重指数（BMI）较高、双侧均有肿瘤、肿瘤组织为PA与嗜铬细胞瘤、肿瘤较大、手术时间更长、术中出血量更多、服药依从性差者。手术前,两组患者的血压、血钾水平、卧位醛固酮水平差异无统计学意义（P>0.05）;术后半年,血压正常组的舒张压、收缩压、卧位醛固酮水平低于高血压组,血钾高于高血压组（P<0.05）。多因素分析显示,术后高血压组患者多为高龄、高BMI、有吸烟史、有饮酒史、双侧均有肿瘤、肿瘤组织为PA与嗜铬细胞瘤、服药依从性差者（P<0.05）。结论 腹腔镜肾上腺切除术对肾上腺性高血压患者的血压有显著影响,术后高血压的控制与多种因素相关,包括年龄、BMI、吸烟史、饮酒史、肿瘤的位置与数量、服药依从性。因此,对于高风险患者,术后应给予更密切的监测和个性化管理。

Objective To analyze the effect of laparoscopic adrenalectomy on blood pressure in patients with adrenal hypertension, and to explore the related influencing factors of postoperative hypertension, so as to improve the clinical effect of the treatment of adrenal hypertension. Methods The clinical data of 100 patients with adrenal hypertension and laparoscopic adrenalectomy screened in the Second Affiliated Hospital of Guangdong Medical University from January 2021 to December 2023 were retrospectively analyzed. They were divided into a normal blood pressure group （n=50） and a hypertension group （n=50） according to blood pressure. All patients received adrenal CT examination, primary aldosteronism （PA） screening test, and adrenal venous blood sampling （AVS）. After half a year of follow-up, the general information, preoperative and postoperative blood pressure, antihypertensive drug use, blood potassium level, aldosterone level of the patients were collected, and the differences between the normal blood pressure group and the hypertension group were analyzed. Results The patients in the hypertension group were mostly male, with smoking history, drinking history, high body mass index （BMI）, bilateral tumors, PA and pheochromocytoma, large tumor, long operation time, large intraoperative blood loss, and poor medication compliance. Before operation, there was no significant difference in blood pressure, serum potassium level, and recumbent aldosterone level between the two groups （P>0.05）.Half a year after operation, the diastolic blood pressure, systolic blood pressure, and recumbent aldosterone levels in the normal blood pressure group were lower than those in the hypertension group, and the serum potassium was higher in the normal blood pressure group （P<0.05）. Multivariate analysis showed that the patients who were elderly, high BMI, smoking history, drinking history, bilateral tumors, PA and pheochromocytoma in tumor tissue, and poor medication compliance had a higher risk of postoperative hypertension （P<0.05）. Conclusion Laparoscopic adrenalectomy has a significant impact on the blood pressure of patients with adrenal hypertension. The control of postoperative hypertension is related to a variety of factors, including age, BMI, smoking history, drinking history, the location and number of tumors, and medication compliance. Therefore, for these high-risk patients, postoperative monitoring and personalized management should be given more closely.