宫腔镜手术的麻醉及电解质、血糖等监测对预防TURS的临床意义

Anesthesia and clinical importance of monitoring blood glucoseand electrolytes during hysteroscopic surgery

目的 :探讨宫腔镜手术的麻醉方法 ,了解电解质、血糖等在宫腔镜手术中的变化。方法 :80例行宫腔镜手术的患者 ,随机分为GA组 (静脉吸入复合全身麻醉组 ,n =36 )和EA(硬膜外麻醉组 ,n =4 4 )。所有的病人均于术前、术中、术后检测电解质 (Na+ 、K+ 、Cl-)、血糖和血气 (HCO3 -、PaCO2 、pH、Hb、Hct) ,同时记录下所用灌流液多少及手术时间。 结果 :两组术中血糖、术后血糖均较术前显著上升 ,术后血糖较术中血糖有所上升。电解质中以血钠变化明显 ,术中、术后较术前显著下降。组间比较无显著差异。两组灌流液量无明显差异。结论 :宫腔镜手术中 ,静脉吸入复合全麻和硬膜外麻醉均可安全使用。电解质、血糖等监测是不可缺少的手段之一。

Objective:To study the management of anesthesia and to assess the changes in blood glucose and electrolytes during operative hysteroscopy.Methods:80 patients undergoing operative hysteroscopy were allocated to GA group (the general anesthesia group, n =36) and EA group (the epidural anesthesia, n =44).The electrolytes (Na +,K +,Cl -),blood glucose,blood gas(HCO - 3,PaCO 2,pH),Hb,Hct were observed before operation,at 30 min during operation and after operation respectively.Meanwhile,the irrigating fluid volume and operation procedure were recorded.Results:The blood glucose level increased markedly at 30 min during operation as compared with that before operation and after operation as compared with that during operation.There was a significant higher blood glucose level after operation than that at 30 min during operation and there was no significant difference between the two groups.Serum sodium was significantly changed in electrolytes.There was a significantly lower sodium level at 30 min during operation as compared with that before operation and after operation as compared with that during operation.There was no significant difference between the two groups.There was also no significant difference between the groups in volume irrigating fluid.Conclusion:The intravenous-inhaled combined anesthesia and epidural anesthesia can be used safely for operative hysteroscopy.It is one of the important means to monitor the blood glucose and electrolytes in operative hysteroscopy.