经尿道前列腺切除术围手术期高危因素的处理经验  

Experience in management of high-risk patients of benign prostatic hyperplasia treated with transurethral resection of prostate

作　　者：韩精超[1] 夏溟[1] 白焱[1] 张继伟[1] 王海涛[1] 何群[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院泌尿外科,100038

出　　处：《中华泌尿外科杂志》2013年第11期843-846,共4页Chinese Journal of Urology

摘　　要：目的 探讨高危BPH患者行TURP术治疗的围手术期高危因素处理经验,以提高手术的安全性. 方法 分析2007年1月至2012年1月115例行TURP术治疗患者的高危因素.伴高血压者,术前将血压调控在140/90 mm Hg（1 mm Hg=0.133 kPa）左右；有心肌梗死者,待病情稳定6个月以上；伴慢性阻塞性肺病者术前戒烟、吸氧、雾化吸入,加强呼吸功能训练,学习正确的排痰方法,合理应用抗生素,使最大肺通气量恢复到70％以上；伴糖尿病者术前应用胰岛素将空腹血糖控制在8 mmol/L以内；合并慢性梗阻性肾功能不全者留置导尿2周以上,使血肌酐控制在130 μmol/L以下；接受抗凝治疗者,术前停药5d以上.术后鼓励患者早期活动,麻醉恢复后即开始间断练习踝关节屈伸运动,并采用气压循环驱动治疗仪辅助预防下肢静脉血栓形成. 结果 115例均安全耐受手术.手术时间30～60 min,切除前列腺组织质量12～37 9,失血量80～ 150 ml.术后留置尿管时间3～7d,拔管后排尿通畅.并发症总发生率为1.7％.术后第3、5天各发生下肢静脉血栓1例,均经抗凝治疗后痊愈.无肺部感染、大出血、TUR综合征等并发症发生. 结论 正确分析TURP围手术期的高危因素并及时有效处理,可提高高危BPH患者行TURP治疗的安全性,降低并发症发生率.Objective To investigate the experience in management of the high risk benign prostatic hyperplasia （BPH） patients in order to improve the safety of the operation. Methods The high-risk fac- tors of 115 patients with BPH who had been treated with transurethral resection of prostate （TURP） were an- alyzed. The blood pressure of hypertensive patients should be controlled below 140/90 mm Hg. The patients with myocardial infarction should be in stable condition for more than 6 months. Smoking cessation, oxygen inhalation, and pulmonary function training should be carried out during the perioperative period in patients with chronic obstructive pulmonary disease, correct expectoration methods and rational use of antibiotics were also needed to improve the maximum amount of pulmonary ventilation to more than 70%. The blood-glucose of diabetic patients should be controlled below 8 mmol/L by insulin. Catheter was indwelled in patients with chronic obstructive renal insufficiency for more than 2 weeks so that the blood Cr could be below 130 μmol/L. Anticoagulant therapy should stop at least 5 days before surgery. Patients were encouraged to have physical training early after surgeIy and to have ankle stretch movement when they recovered form anesthesia, and pressure cycle drive therapeutic apparatus ,sere atso used to prevent deep venous thrombosis. Results At1 the patients tolerated TURP safely. Operation time was 30 to 60 min, the weight of the resection prostate tis- sue was 12 to 37 g, blood loss was 80 to 150 ml, and catheterization time was 3 to 7 days.The overall inci- dence of complications was 1.7%. There were 2 cases with deep venous thrombosis, who recovered after anticoagulant therapy. There were no pulmonary infection, bleeding, TUR syndrome, and other complications. Conclusion Correct analysis and effective management of the perioperative risk factors in high-risk BPH patients treated with TURP can improve the safety of the operation and reduce the complications.

关 键 词：前列腺增生 高危 经尿道前列腺切除术 手术期间 

分 类 号：R699[医药卫生—泌尿科学]