经尿道前列腺电切术的失血观察及血凝酶应用的效果分析

Blood loss of transurethral resection of prostate and effect of hemocoagulase usage after TURP

目的:观察经尿道前列腺电切术(TURP)患者术中和围手术期失血情况及其影响因素,观察注射用血凝酶(立芷雪)对TURP术后失血的作用和安全性。方法:BPH患者60例随机分为研究组1、组2(不同治疗方案)和对照组各20例,行TURP术,对比观察两组术前、术后第1天和第3天血红蛋白、出凝血并发症、是否输血、切除的前列腺体积、手术时间、术后膀胱持续冲洗时间、拔管时间、术后住院时间。研究组术后使用血凝酶,治疗方案1:研究组在术后用2000U静脉小壶滴入,每天1次,共3天;治疗方案2:研究组术后仅用一次2000U静脉小壶滴入。对照组术后不用任何止血药。结果:全部患者手术成功,无并发症发生。主要观察指标:研究组1第1天血红蛋白97～132g/L,平均118g/L;第3天血红蛋白98～130g/L,平均116g/L。研究组2第1天血红蛋白100～130g/L,平均117g/L;术后第3天血红蛋白99～127g/L,平均112g/L。对照组术后第1天血红蛋白92～130g/L,平均113g/L,两组比较差异有统计学意义(P<0.05),术后第3天血红蛋白93～124g/L,平均10.9g/L,与组1比较P<0.01,与组2比较P<0.05。研究组2和对照组各有1例分别于手术当天和术后第2天输血。全部患者无心、脑血管意外和血液系统意外。次要观察指标三组比较差异无统计学意义。结论:TURP失血较多,尤其对前列腺较大和手术时间较长的患者。失血量主要与前列腺体积、手术时间、术者操作技术等因素相关。术后应用注射用血凝酶可以减少术后失血,不会增加凝血异常引起的心、脑血管疾患,特别是对并发心、脑血管疾病的患者更有益处。

Objective：To assess blood loss of transurethral resection of prostate and corresponding factors. To observe the effect of hemocoagulase usage after TURP. Methods： A total of 60 cases BPH undergoing TURP were reviewed and analyzed. All cases were divided into tree groups by randomized. All the items we observed were blood loss after TURP, transfusion, complication of operation, weight of resected tissue, time use of operation, time for rinsing postoperative, time for off catheter and hospitalization postoperative. Group one was used hemocoagulase 2 ku per day for total three days. Group two was used hemocoagulase 2 ku once right away after operation. Group three was no hemocoagulase used. Results： All cases were succeeded with TURP with no complication happened. In group one, haematochrome before TURP were from 111-160 g/L, average was 135 g/L. One day postoperative the haematochrome fell to 97-132 g/L, average was 118 g/L. Three days postoperative the haematochrome fell to 116 g/L for average. In group two, there were no difference of haematochrome one day postoperative compared to group one, but there were difference of haematochrome three days postoperative （P〈0.05）. In group three, there were difference of haematochrome both one day and three days postoperative （P〈0.01）. There were two cases received transfusion on the operation day and the next day respectively. Other items in three groups were no differences. Conclusions： The blood loss of TURP was really much, especially for big prostate and long time TURP. The important factors were the volume of prostate, time of operation, technique of operation. Use haematochrome right away after TURP would , duce blood loss and no blood complication increased. It would be benefit for old cases especially with cardiac disreae.