经尿道电切术的内毒素血症

Endotoxemia and transurethral resection

１９９３年１～８月测定４３例经尿道电切术（ＴＵＲ）患者术前、术中血内毒素浓度变化，探讨ＴＵＲ内毒素血症与临床意义．患者男性３９例，女性４例．其中良性前列腺增生（ＢＰＨ）１７例，ＢＴＣＣ１９例，膀胱颈口梗阻７例．年龄１７～７５岁，平均５７．１岁．随机选择分为两组，Ⅰ组２１例，仅口服抗生素；Ⅱ组２２例，静脉滴注先锋霉素Ⅵ２ｇ后方实施ＴＵＲ．内毒素测定采用鲎试验的合成基质偶氮显色（ＬＬＴ）．结果显示两组间术前与术中的内毒素变化差值具有显著性意义（Ｐ＜０．０５）．研究说明，ＴＵＲ可导致血内毒素浓度的明显增高，ＴＵＲ术中的内毒素浓度直接影响术后发热及并发症，术前静脉给予有效、足量抗生素对预防和减少ＴＵＲ术中内毒素血症和术后并发症有效，其机理由于ＴＵＲ中的细菌总量减少，血液内毒素浓度降低，并使术后细菌感染率下降．

Blood endotoxin (ET) level was determined both before and during transurethral resection(TUR)in 43 cases in order to investigate the correlation between endotoxemia and TUR syndrome, The patients were divided at random into two groups:group Ⅰ(n =21 )antibiotics were administered orally and group Ⅱ(n=22), 2g cephradine was instituted intravenously before TUR in addition to the oral administration, There were 39 male adults and 4 females, inchding 17 BPH,19bladder transitional cell carcinoma and 7 bladder neck obstruction, The age of the patients ranged from 17 to 75 (median 57.1).Themeasurement of Hood ET was under taken by limulus lysate test(LLT ) and the differences of ET Ievels before and during TUR and between the 2 groups were statistically significant (P<0. 05). Postoperative pyrexia and some other complications were closely related to ET level during TUR.Preoperative administration of antibiotics has been effective in the control of endotoxemia and hence the prevention of postoperative complications.