经尿道前列腺切除术中膀胱洗液量对高龄患者血流动力学及内环境的影响  

Impact of amount of the bladder lavage on hemodynamic and internal environment during transurethral resection of prostate for elderly patients

作　　者：侯岩松 何屹 王华[1] 朱崴 

机构地区：[1]嘉兴市第一医院泌尿外科,浙江嘉兴314000

出　　处：《中国性科学》2016年第5期11-14,共4页Chinese Journal of Human Sexuality

基　　金：浙江省医药卫生一般研究计划项目(2012KYB204)

摘　　要：目的:分析经尿道前列腺电切术中膀胱洗液量对血流动力学及内环境影响。方法:80例前列腺增生患者,分为观察组和对照组。两组患者均采用经尿道前列腺电切术治疗,对照组患者给予乳酸林格氏液维持血容量,观察组先给予高渗氯化钠羟乙基淀粉40注射液预先干预,再给予乳酸林格氏液维持血容量。观察两组患者于手术开始瞬间(T_1)、膀胱灌洗液量达12000 m L(T2)、21000 m L(T3)、30000 m L(T4)时电解质、血压、心率和胸阻抗变化。结果:两组患者术中血Na+水平进行性下降,在T3和T4时点,对照组血Na^+下降较观察组明显,差异具有统计学意义(P<0.01)。术中,血K^+、Ca^(2+)、胸阻抗指标、血压和心率,两组比较差异无统计学意义(P>0.05)。观察组患者膀胱灌洗过程中胸阻抗指标、血压和心率比较,差异无统计学意义(P>0.05)。结论:患者经尿道前列腺电切术手术麻醉过程中适量使用高渗氯化钠羟乙基淀粉40注射液能够明显缩小使患者血Na+变化幅度减小,且不影响患者血流动力学。Objectives： To analyze the impact of amount of the bladder lavage on hemodynamic and internal environment during transurethral resection of prostate for elderly patients. Methods： 80 patients with prostatic hyperplasia were divided into observation group and control group. Two groups of patients were treated with transurethral resection. The control group was treated with Ringer＇s lactate to maintain blood volume. Observation group received pre- intervention of 40 injection of hypertonic sodium chloride hydroxyethyl starch and then was given Ringer＇s lactate to maintain blood volume. The changes in electrolyte,blood pressure,heart rate,chest impedance at the beginning of surgery（ T_1）,bladder irrigation fluid volume of 12000 m L（ T2）,21000 m L（ T3） and 30000 m L（ T4） of the two groups were observed. Results： In the surgery,the levels of Na ＋ decreased in two groups. At the time of T3 and T4,the level of Na ＋ decreased and control group decreased more than observation group,with statistically significant difference（ P〈0. 01）. K~＋ and Ca^（2＋）blood level,thoracic impedance index,blood pressure and heart rate were of no statistically significant difference（ P〉0. 05）. Conclusion： Appropriate use of hypertonic sodium chloride hydroxyethyl starch 40 injection in the process of anesthesia for patients treated by transurethral resection of prostate can significantly reduce the level of blood Na＋and do not affect the patients＇ blood flow dynamics.

关 键 词：经尿道前列腺电切术 前列腺增生 膀胱洗液量 内环境 

分 类 号：R697.32[医药卫生—泌尿科学]