前列腺电汽化切除术中麻醉监测的临床意义

Clinical significance of anaesthesia monitoring hemodynamics and blood biochemical indexes with perioperative transurethral electro-vaporization of prostate

目的观察前列腺电汽化切除术中病人血流动力学及血糖、电解质、红细胞压积等指标的变化并分析其临床意义,指导临床预防前列腺电切综合征的发生。方法选择40例ASAⅠ～Ⅲ级,择期前列腺电汽化切除术手术患者。均采用连续硬膜外阻滞,选择L_(2～3)穿刺、头向置管3．5cm。术中输液用复方氯化钠液、聚明胶肽,补液速度控制在8～15ml·kg^(-1)·h^(-1)。分别于手术前、手术开始后30、50mmin和术毕时,抽取中心静脉血4ml检查血糖、电解质(Na^+、K^+、Cl^-)、血红蛋白、红细胞压积等。记录这四个时间点的血流动力学指标(MAP、HR、CVP)。结果手术开始后,CVP有逐渐上升趋势,术毕有明显升高(P＜0．05)。术中、术后的MAP、HR与术前比较无明显差异(P＞0．05)。与术前比较,血糖于术中50min和术毕时明显高于术前水平(P＜0．01);血清Na^+、Cl^-;血红蛋白、红细胞压积于术毕显著降低(P＜0．01;P＜0．05)。术中6例病人出现寒战反应;2例出现低钠、高血糖(Na^+＜125mmol/L,Glu＞10．0mmol/L),发生时间均在120min以上。40例病人麻醉效果满意,出血不多。结论前裂腺电汽化切除术术中CVP、血糖和电解质的监测对指导临床预防前列腺电切综合征的发生有重要作用。麻醉中病人的体温保护和冲洗液出入量的监测应引起重视。

Objective To observe the changes of hemodynamics and blood biochemical indexes, such as serum glucose, dielectric,etc, in perioperative transurethral electrovaporization of prostate,and to prevent the transurethral resection syndrome （TURS）. Methods 40 cases of patients of ASA physical status Ⅰ～Ⅲ undergoing transurethral electrovaporization of prostate surgery were selected. All the patients were conducted epidural anesthesia puncture from lumbar 2 - 3 spinal interspace,3.5cm. Sodium Chloride and Polygeline were infused during operation （8-15ml· kg^-1·h^-1）. The blood sugar （Glu）, dielectri（ Na^＋,K^＋ ,Cl^- ）, Hb and Hct were measured before operation,at 30 min and 50min after operation,and at the end of operation,while hemodynamics indexes（MAP,HR,CVP） were recorded at the same times. Results CVP increased significantly at the end of operation （P 〈0.05）. MAP and HR did notchanged significantly （P〉0. 05） during the operation. The Glu at 50min and the end of operation were significantly higher（P 〈0. 01 ） than before operation. Serum Na^＋ ,Cl^-, Hb and Hct reduced significantly （ P 〈0. 01 ; P 〈 0. 05） at the end of the operation. 6 patients trembled with cold during the operation,and 2 patients had hypopotassaemia and hyperglycemia（ Na ^＋ 〈 125mmol/L,Glu 〉 10. 0mmol/L）at 120min after operation. 40 patients had been done epidural anesthesia successfully,and the bleeding was minor. Conclusions CVP, Blood sugar and electrolyte monitoring could effectively preven TURS,temperature and more attention should be paid to the intake and output volume of rinsing fluid monitoring.