宫腔镜手术不同膨宫压力和灌流介质对患者血钠水平的影响  

Influence of Different Irrigating Medium and Distending Pressure on the Level of Blood Sodium in Patients Undergoing Hysteroscopic Operation

作　　者：陈蔚[1] 段华[1] 成九梅[1] 郭银树[1] 

机构地区：[1]首都医科大学附属北京妇产医院妇科微创中心,北京100006

出　　处：《中国微创外科杂志》2012年第3期250-253,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：卫生行业科研专项基金(项目号:200802071)

摘　　要：目的观察宫腔镜手术中不同膨宫压力和灌流介质下患者血钠水平的变化,为降低体液超负荷发生率提供依据。方法根据术中压力与介质的不同将62例宫腔镜手术按抽签方式分为膨宫压力100 mm Hg 5%葡萄糖组(100+GS,n=16)及生理盐水组(100+NS,n=15);130 mm Hg 5%葡萄糖组(130+GS,n=16)及生理盐水组(130+NS,n=15)。分别于术前,术后0 h、4 h、12 h取静脉血,检测各组手术前后血清钠的水平。结果 (1)2个5%葡萄糖组血钠术后0 h降至最低点(P<0.05);2个生理盐水组术后4 h降至最低点(P<0.05)。130+GS组血钠变化最显著,与2个生理盐水组比较差异有统计学意义(P<0.05)。(2)130+GS组稀释性低钠血症发生率31%(5/16),其中重度占12%(2/16),130+NS组15例均无稀释性低钠血症发生,两组差异有显著性(P=0.043)。100+GS组稀释性低钠血症发生率12%(2/16),100+NS组为6%(1/15),两组比较差异无显著性(P=1.000)。2个5%葡萄糖组稀释性低钠血症共7例,均发生在灌流介质吸收量>1000 ml时,发生率为78%(7/9),其中2例重度者灌流介质吸收量分别为2000、1300 ml,灌流介质吸收<1000 ml的23例无稀释性低钠血症发生,两者差异有显著性(P=0.000)。结论选择电解质介质灌流的宫腔镜手术,对维持机体血钠指标的稳定效果优于非电解质介质;使用非电解质介质灌流宫腔应慎重增加膨宫压力,以避免体液超负荷的发生。Objective To observe the change of blood sodium level during hysteroscopic operation with different irrigating medium and distending pressure,so that to find out a way to avoid dilutional hyponatremia.Methods Sixty-two in-patients were randomly divided into four groups according to distending pressure and irrigating medium： 100 mm Hg 5% glucose（100＋GS,n=16）,100 mm Hg 0.9%saline（100＋NS,n=15）,130 mm Hg 5% glucose（130＋GS,n=16）,and 130 mm Hg 0.9%saline（130＋NS,n=15） groups.Blood samples were collected from the patients before the operation,at the end of the operation,and 4 and 12 hours after the operation,for measuring the level of blood sodium. Results（1） In both the 5% GS groups,the level of blood sodium reached the bottom at the end of the operations（P0.05）;while in the both 0.9%NS groups,it reached the bottom 4 hours after the operation（P0.05）.Compared with the two 0.9%NS groups,the 130＋GS group showed the most significant change in the level of blood sodium（P0.05）.（2） The incidence of dilutional hyponatremia in the 130＋GS group was 31%（5/16）,which was significantly higher than that in the 130＋NS group（0,P=0.043）.The incidence of severe dilutional hyponatremia in the 130＋GS group was 12%（2/16）.The incidence of dilutional hyponatremia in the 100＋GS group was 12%（2/16）,which was similar to that in the 100＋NS group [6%（1/15）,P=1.000].In the two 5%GS groups,there were totally seven cases of dilutional hyponatremia [78%（7/9）].Two of the seven cases were severe;they absorbed respectively 2000 and 1300 ml of the irrigating medium.In the patients who absorbed the medium less than 1000 ml（23 cases）,no dilutional hyponatremia occurred（P=0.000）.Conclusions Electrolytic solution is superior to non-electrolytic solution in keeping the balance of blood electrolytes.When using non-electrolytic solutions,it should be careful to increase the distending pressure to avoid the complication of overload.

关 键 词：宫腔镜 膨宫压力 灌流介质 稀释性低钠血症 血钠 

分 类 号：R713[医药卫生—妇产科学]