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目的探讨不同方法预防前列腺电切术综合征的时效关系。方法选择60例择期前列腺增生手术患者,年龄70~85岁。手术时间在45 min之内结束为Ⅰ组;手术在1.5 h之内为Ⅱ组,于手术一开始就缓慢静脉滴注3%氯化钠溶液,手术时间在60 min及手术结束时分别静脉推注速尿20 mg进行处理;手术时间>2 h为Ⅲ组,手术开始前充盈膀胱,于耻骨上3 cm处穿刺造瘘,其余同Ⅱ组。开始估测手术时间不符的排除实验,每组20例。分别于术前(T0)、手术开始后1 h(T1)、2 h(T2)、4 h(T3)时点各采患者肘正中静脉血3 ml,取少量测血糖(Glu),其余测定电解质。结果三组患者均无一例发生前列腺增生电切综合征。Ⅰ组与术前比较各时点Na+、K+、Cl-和Glu差异均无统计学意义(P>0.05);Ⅱ和Ⅲ两组与术前比较,各时点K+浓度差异无统计学意义(P>0.05),T2、T3时点Na+、Cl-浓度下降,差异有统计学意义(P<0.05或P<0.01),而Glu浓度升高,差异有统计学意义(P<0.05或P<0.01)。结论预防尿道电切综合征(TURS)发生应采取以下的治疗措施:①手术时间应限制在1 h左右,如不能完成手术,应预防性的使用高渗盐水和利尿剂,手术时间更长或心肺功能较差的老年患者,应在手术前进行膀胱造瘘灌注,并保持畅通;②高龄老年患者或术前有糖尿病的患者要用5%甘露醇作为灌洗液,甘露醇不含电解质,只有6%~10%被吸收代谢掉,其余被肾脏滤过并以原形排泌于尿液中;③经尿道前列腺电切术围术期应加强对血钠和血糖等的监测,一旦出现明显异常,应尽快给予对症处理治疗。
Objective To investigate the time-effect relationship of different methods in preventing prostatectomy syndrome. Methods Sixty patients undergoing elective prostate hyperplasia were selected, aged 70-85 years. The operation time ended within 45 min in group Ⅰ. Within 1.5 h, operation was performed in group Ⅱ. Slow intravenous infusion of 3% sodium chloride solution was performed at the beginning of operation. The operation time was set at 60 min and at the end of operation. Injection of 20 mg furosemide for treatment; operation time> 2 h for the group Ⅲ, filling the bladder before surgery, puncture in the pubic symphysis 3 cm Department, the rest with the group Ⅱ. Begin to estimate the operation time does not match the exclusion experiment, 20 cases in each group. Blood samples were taken from the elbow of each patient 3 ml before surgery (T0), 1 h (T1), 2 h (T2), and 4 h (T3) Electrolyte. Results None of the three groups had BPH syndrome. There was no significant difference in the levels of Na +, K +, Cl- and Glu at each time point between the two groups (P> 0.05). There was no significant difference between the two groups (P <0.05 or P <0.01), while the concentration of Glu increased, the difference was statistically significant (P <0.05 or P <0.05 or P <0.05) 0.01). Conclusion The following measures should be taken to prevent the occurrence of TURS: ① The operation time should be limited to 1 h. If the operation can not be completed, the hypertonic saline and diuretic should be used prophylactically. The operation time should be longer or longer Elderly patients with poor cardiopulmonary function should be carried out before surgery, bladder fistula perfusion, and to maintain smooth; ② elderly patients or preoperative diabetes patients with 5% mannitol as a lavage fluid, mannitol without electrolytes, Only 6% to 10% are absorbed and metabolized, and the rest are filtered by the kidney and excreted in urine in the form of prototype; Transurethral resection of the prostate should be strengthened perioperative monitoring of blood sodium and blood glucose, once the obvious Abnormal, symptomatic treatment should be given as soon as possible.