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目的探讨预先输入高渗盐水在前列腺增生(BPH)患者行经尿道前列腺电切术(TVP)时预防电切综合征(TURS)的临床效果。方法选择行TVP的高危重度BPH患者40例,ASAⅡ~Ⅲ级,随机分成两组,S组为实验组,手术开始后,以1.5 ml/(kg.h)的速度泵入1.8%的氯化钠溶液。HS组为对照组,术中间断静脉注射10%的NaCl溶液。两组患者均采用L2-3间隙腰-硬联合麻醉,术中监测平均动脉压、心率、呼吸、脉搏血氧饱和度。抽取对侧肘静脉血检测血钠、血钾、血氯、血糖的变化。记录两组患者的TURS发生率、手术时间及术中冲洗液用量。结果与术前(T0)相比,S组MAP,HR,R,SpO2,Glu,Na+,K+,Cl-浓度无明显变化(P>0.05);HS组R,SpO2,Na+,K+,Cl-浓度无明显变化(P>0.05),MAP在30 min(T30)、60 min(T60)时明显下降(P<0.01),HR在T30,T60时也下降(P<0.05),Glu T60与T30相比升高(P<0.01),T60与T0相比明显升高(P<0.001)。两组各时间点比较,T60MAP差异有显著性(P<0.01),Glu差异有显著性(P<0.01),T30Glu差异有显著性(P<0.05),HR,R,SpO2,Na+,K+,Cl-浓度差异无显著性(P>0.05)。两组患者均未出现高钠血症,HS组发生1例TURS。结论术前预先持续输入1.8%的高渗盐水可以预防TURS的发生,并且效果优于术中间断静脉注射10%的NaCl溶液。
Objective To investigate the clinical effect of pre-infusion of hypertonic saline on preventing transurethral resection syndrome (TURS) during transurethral resection of prostate (TVP) in patients with benign prostatic hyperplasia (BPH). Methods Forty patients with high-risk severe BPH who were treated with TVP were randomly divided into two groups (ASAⅡ-Ⅲ). The patients in experimental group were treated with 1.5ml / (kg · h) Sodium solution. HS group as control group, intraoperative intravenous injection of 10% NaCl solution. L2-3 gap lumbar-hard anesthesia was used in both groups, mean arterial pressure, heart rate, respiration and pulse oximetry were monitored intraoperatively. Extraction of contralateral cubital vein blood serum sodium, potassium, blood chlorine, blood glucose changes. The incidence of TURS, the operation time and the amount of irrigation fluid in both groups were recorded. Results There were no significant changes in the concentrations of MAP, HR, R, SpO2, Glu, Na +, K + and Cl- in group S compared with that before operation (P> 0.05) MAP significantly decreased at 30 min (T30) and 60 min (T60) (P <0.01), HR decreased at T30 and T60 (P <0.05), Glu T60 and T30 (P <0.01), T60 was significantly higher than T0 (P <0.001). There were significant differences in T60MAP (P <0.01), Glu (P <0.01), T30Glu (P <0.05), HR, R, SpO2, Na +, K + Cl- concentration difference was not significant (P> 0.05). No hypernatremia occurred in both groups, and one case of TURS occurred in HS group. Conclusion The preoperative continuous infusion of 1.8% hypertonic saline can prevent the occurrence of TURS, and the effect is better than intermittent intravenous injection of 10% NaCl solution.