经尿道前列腺电汽化术中的临床意义

Blood glucose surveillance in transurethral vaporization of prostate

目的 :了解经尿道前列腺电汽化术 (TVP)患者术中冲洗液吸收的情况 ,并探讨其与手术操作及电切综合征 (TURS)发生的关系。方法 :TVP手术中用 5 %葡萄糖液作冲洗液 ,通过监测患者术前及术中血糖的变化 ,观察TURS的发生及手术情况 ,分析血糖变化与冲洗液吸收之间的关系。结果 :85例患者随手术时间的延长 ,血糖逐渐升高 ,空腹血糖术前为 (4 .71± 0 .6 3)mmol/L ,手术开始后 30、6 0、90、12 0min监测一次血糖 ,其值分别为(5 .98± 2 .6 5 )mmol/L、(8.79± 6 .5 8)mmol/L、(9.5 6± 8.2 0 )mmol/L、(11.14± 8.79)mmol/L。手术结束后 1h血糖值 (6 .82± 3.96 )mmol/L ,术前与术中比较均P <0 .0 1。有 19例术中发生包膜轻微裂开或穿孔 ,2例血糖明显升高者术中出现TURS症状。结论 :TVP术中血糖升高 ,说明有冲洗液吸收 ,其血糖升高的幅度可反映吸收的速度与量 ,且与手术操作情况明显相关 ,5 %葡萄糖液作冲洗液时 ,术中血糖升高可看作TURS的先兆症状 ,TVP术中血糖监测有利于早期发现TURS。

Objective:To study the amount of irrigating fluid absorbed in Transurethral Vaporization of Prostate (TVP) and to look for the relationship between operative technic and the occurrence of transurethral resection syndrome (TURS).Method:We used 5% glucose solutions as TVP irrigating fluid for 85 patients, monitor blood glucose level before and during TVP and observed the operative course, the symptoms of TURS.Result:The blood glucose increased during operation markedly associated with the operating time. The blood glucose level was ( 4.71± 0.63) mmol/L before operation,( 5.98± 2.65) mmol/L,( 8.79± 6.58) mmol/L, ( 9.56± 8.20) mmol/L, ( 11.14± 8.79) mmol/L,( 6.82± 3.96) mmol/L at 30 min, 60 min, 90 min, 120 min during operation and 60 min after operation, respectively. The blood glucose level increased significantly when compared with preoperative level(P< 0.01). There were 19 patients had perforation of prostate capsule and 2 patients had the symptoms of TURS accompanied with markedly high blood glucose level.Conclusion:The blood glucose increasing during operation indicate that there is absorption of irrigating fluid in TVP, the level of high blood glucose could represent the volume and velocity of the absorption and associated with the operative situations. The rise of blood glucose could be recognized as early symptom of TURS and the monitoring is helpful for early diagnosis of TURS.