不同麻醉方法对行尿道电切合并绿激光前列腺汽化术患者血流动力学和电解质的影响

Effect of different anesthetic techniques on hemodynamics and electrolyte in patients undergoing transurethral electrotomy and photoselective vaporization of the prostate

目的观察不同麻醉方法下行尿道电切合并绿激光前列腺汽化术患者围术期血流动力学和血电解质的变化,探讨不同麻醉方法的临床实用性和安全性。方法选择美国麻醉医师学会分级Ⅰ～Ⅲ级,行择期尿道电切合并绿激光前列腙汽化术的患者45例,均分为3组。A组行蛛网膜下隙阻滞麻醉,B组行硬脊膜外腔阻滞麻醉,C组行静吸复合全身麻醉。采用美国Cardiodynamics公司的Bioz.com无创血流动力学监测系统监测血流动力学,监测内容包括心率(HR)、血压(BP)、心搏出量(CO)、心脏指数(CI)、体循环血管阻力(SVR)和胸液成分(TFC);并在手术开始和结束时采静脉血测血清钠、钾、氯、血红蛋白(Hb)和红细胞压积(HCT)。结果与术前相比,A组麻醉后15和30 min的MAP、HR、CO、CI和SVR均显著降低(P值均<0.05),C组麻醉后5 min的MAP、CO、CI和SVR均显著降低(P值均<0.05),B组血流动力学各项指标均无明显变化(P值均>0.05);B、C组麻醉后15和30 min的MAP、HR、CO、CI和SVR均显著高于A组同时间点(P值均<0.05);C组麻醉后5 min的MAP、CO、CI和SVR均显著低于B组同时间点(P值均<0.05)。与术前相比,3组术毕时血清钠、钾、氯均无明显变化(P值均>0.05),Hb、HCT均显著降低(P值均<0.05)。结论蛛网膜下隙阻滞麻醉、硬脊膜外腔阻滞麻醉及静吸复合全身麻醉均可应用于尿道电切合并绿激光前列腺汽化术。蛛网膜下腔阻滞麻醉对血流动力学有一定抑制作用,全身麻醉在诱导时对心血管的抑制应予以关注,硬脊膜外腔阻滞麻醉对血流动力学影响较小、安全可靠。

Objective To observe the effects of three different anesthetic techniques on hemodynamics and electrolyte in patients undergoing photoselective vaporization of the prostate （PVP） and transurethral eleetrotomy, so as to assess the practicability and safety of different anesthetic techniques. Methods Forty-five male patients with benign hyperplasia, who met the American Society of Anesthesiologists （ASA） Ⅰ -- Ⅲ undergoing PVP and transurethral eleetrotomy were divided into 3 groups （n=15 each） ： group A received spinal anesthesia, group B received epidural anesthesia, and group C received general anesthesia. Hemodynamics including heart rate （HR）, blood pressure （BP）, cardiac output （CO）, cardiac index （CI）, systemic vascular resistance （SVR） and thoracic fluid content （TFC） were measured during perioperative period. The blood electrolytes, hemoglobin （Hb） and hematocrit （HCT） were also measured during perioperative period. Results Significant decrease in MAP, HR, CO, SVR and CI were observed in group A at 15 or 30 min after anesthesia compared with those before operation （all P〈0.05）. Significant decrease in MAP, CO, SVR and CI were also observed in group C at 5 min after anesthesia compared with those before anesthesia （all P〈0.05）. There was no significant hemodynamics change in group B （all P〉0. 05）. The values of MAP, HR, CO, SVR and CI in group B and group C were higher than those in group A at 15 or 30 min of anesthesia induction （all P〈0.05）. The MAP, HR, CO, CI and SVR at 5 min of anesthesia induction in group C were significantly lower than those in group B （all P〈0.05）. Compared with before operation, there were no significant changes in serum levels of sodium, potassium and chloride at the end of operation （all P〉0. 05） ; but the Hb and HCT were significantly decreased （all P〈 0.05 ）. Conclusion Spinal, epidural and general anesthesia can all be used in photoselective vaporization of the prostate （PVP） and transurethral electrotomy. Spinal anesthesia can depress hemodynamics. General anesthesia also depresses hemodynamics during induction, which should be emphasized during general anesthesia. Epidural anesthesia has little effect on hemodynamics, and it is safe and reliable.