经尿道前列腺电切术中冲洗液吸收量和出血量的监测研究  

Surveillance study of irrigating fluid absorption and bleeding in transurethral resection of the prostate

作　　者：马俊海[1] 范宁[1] 鲁骋洲 桂惠明[1] 张耘新[1] 吴恭瑾[1] 常宏[1] 秦泽 岳中瑾[1] 米军[1] 杨立[1] 田俊强[1] 尚攀峰[1] 董治龙[1] 王志平[1] Ma Junhai;Fan Ning;Lu Chengzhou;Gui Huiming;Zhang Yunxin;Wu Gongjin;Chang Hong;Qin Ze;Yue Zhongjin;Mi Jun;Yang Li;Tian Junqiang;Shang Panfeng;Dong Zhilong;Wang Zhiping(Department of Urology,Second Hospital of Lanzhou University,Gansu Nephro-Urological Clinical Center,Key Laboratory of Disease of Urological System Gansu Province,Lanzhou 730030,China;Department of Urology, Haikou People's Hospital,Haikou 570208,China)

机构地区：[1]兰州大学第二医院泌尿外科甘肃省泌尿系疾病临床医学中心甘肃省泌尿系疾病研究重点实验室,兰州730030 [2]海口市人民医院泌尿外科,海口570208

出　　处：《中华泌尿外科杂志》2019年第1期37-41,共5页Chinese Journal of Urology

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2017-07);甘肃省引导科技创新发展专项资金项目(2017ZX-01);兰州大学中央高校基本科研业务费专项资金(lzujbky-2018-k06).

摘　　要：目的 探讨内腔镜手术监测仪在经尿道前列腺切除术(TURP)术中监测冲洗液吸收量和出血量的效果。 方法 2013年1—6月采用自主研制的内腔镜手术监测仪,在体外模拟TURP术中测量冲洗液吸收量和出血量。内腔镜手术监测仪采用压力传感器监测术中冲洗液的出入量,采用光电探头依据光电转换原理监测流出液中血红蛋白浓度,根据流出液体积及患者术前血红蛋白浓度推算出术中出血量,最后依据冲洗液的出入量、术中出血量和患者尿量,计算冲洗液吸收量=(冲洗液流入量-冲洗液流出量)+术中出血量+尿量。术中可将监测仪设置为冲洗液吸收量≥1 000 ml或出血量≥300 ml时发出蜂鸣报警声,以起到预警作用。体外实验采用5%甘露醇溶液持续性灌洗,灌洗过程中随机抽取5次冲洗液,每次100 ml,共500 ml,记录每次抽取冲洗液时内腔镜手术监测仪显示的冲洗液模拟吸收量。在灌洗过程中,随机在模拟人体体腔的容器内滴入5次人全血,每次5 ml,共25 ml,记录内腔镜监测仪显示的模拟出血量。以上过程重复3次,观察监测仪测量值与实际数值的差异。2016年10月至2017年4月前瞻性纳入收治的良性前列腺增生患者。纳入标准:年龄≥50岁;经腹壁B超检查测量前列腺体积≥60 ml;最大尿流率≤15 ml/s;国际前列腺症状评分≥8分。在内腔镜监测仪监测下行TURP,比较手术前后的血流动力学、血清离子浓度、血红蛋白及血细胞比容变化。根据手术时间分为<60 min组和≥60 min组,比较两组的冲洗液吸收量和出血量。 结果 模拟试验中,5次抽取冲洗液后的模拟吸收量分别为(100.60±2.07)ml、(201.00±3.39)ml、(302.00±4.67)ml、(403.60±4.39)ml和(502.40±7.57)ml,5次滴入人全血后的模拟出血量分别为(5.06±0.11)ml、(10.10±0.16)ml、(15.04±0.15)ml、(20.06±0.11)ml和(25.10±0.16)ml,模拟吸收量和出血量与实际数值比较差异均无统计学意义(P>0.Objective To investigate the effect of the endoscopic surveillance system in irrigating fluid absorption and bleeding during transurethral resection of the prostate.Methods In vitro trials,we simulated the fluid absorption and bleeding in the operation by using self-developed endoscopic surveillance system from January 2013 to June 2013.Continuous irrigation of 5 % mannitol solution,we extracted 5 times irrigating fluid (each time 100 ml and a total of 500 ml) in the process of irrigation and recorded absorption measurements of every time extraction rinses.At the same time,we dripped human whole blood 5 times(each time 5 ml and a total of 25 ml) in the process of irrigation and recorded the bleeding measurements.The above process was repeated three times to detect the accuracy and consistency of the endoscopic surveillance system.In clinical trials,50 cases of BPH were monitored in surgery and the biochemical index,hemodynamics,irrigating fluid absorption and bleeding were compared from October 2016 to April 2017.The included criteria contained as follow:the age of patients should be more than 50 years.The transabdominal ultrasound showed that the volume of prostate should be more than 60 ml.The maximal uroflowmetry should be less than 15ml/s.The IPSS scores should be more than 8.Based on the operative time,two groups (<60 min and ≥ 60 min) were classified.Results We developed the endoscopic surveillance system which is original in the world.In vitro trials,the average irrigating fluid were (100.60 ± 2.07) ml,(201.00±3.39) ml,(302.00±4.67) ml,(403.60±4.39) ml and (502.40 ±7.57) ml;and the average bleeding were (5.06 ± 0.11) ml,(10.10 ± 0.16) ml,(15.04 ± 0.15) ml,(20.06 ± 0.11) ml and (25.10 ± 0.16) ml.No significant difference was observed in all groups (P > 0.05).In clinical trials,we compared some preoperative and postoperative indexes.The average blood oxygen saturation were (94.46 ± 2.49) % and (92.39 ± 2.77) % (P < 0.01),the average Serum sodium ion concentration were (141.05 ± 2.52) mmol/L an

关 键 词：内腔镜手术监测仪 冲洗液吸收 出血量 经尿道前列腺电切术 

分 类 号：R699.8[医药卫生—泌尿科学]