甘露醇预防老年患者前列腺电切术综合征的临床观察

Clinical Observation about Mannitol Preventing TURS in Senile Patients

目的探讨前列腺增生症(BPH)患者行前列腺电气化手术(TUVP)中,应用5%甘露醇注射液作为灌洗液预防老年患者前列腺电切综合征(TURS)的临床效果。方法选择我院70～94岁BPH患者92例。ASA分级Ⅰ～Ⅲ级。随机分为两组:A组为实验组,灌洗液用5%甘露醇注射液;B组为对照组,采用传统的5%葡萄糖注射液作灌洗液。两组患者均行硬腰联合麻醉或持续硬膜外麻醉。抽取静脉血,检测术前(T0)、手术30min(T30)、手术60min(T60)时,血钠、血钾、血糖、血红蛋白、红细胞比容值,术中监测平均动脉压、心率。记录两组病人的TURS发生率、手术时间、灌洗液用量、术中输液量。结果与术前相比,A组MAP、HR、Na+、K+、Glu、Hb、Hct,无明显变化(P>0.05);B组T60时,MAP、Na+、Hb、Hct下降(P<0.05),Glu在T30时增高,T60时明显升高(P<0.01),两组各时间点相比,T60时MAP、Hb、Hct有显著差异性(P<0.05),Glu有非常显著差异(P<0.01)。A组无1例发生TURS,B组发生TURS4例,占8%。结论5%甘露醇注射液作为TUVP术中灌洗液,与5%葡萄糖灌洗液相比,可以减少灌洗液吸收,减少老年患者TURS发生率。

Objective The clinical effect was researched that using 5 % mannitol injection as irrigating solution prevent transurethral resection （TURS） in senile patients during the transurethral resection of prostate （TUVP） of benign prostate hyperplasia （BPH） patients. Methods 92 BPH patients, ASA Ⅰ - Ⅲ degree, between 70 and 94 years old in our hospital were fractionated into two random groups. A was experiment group, irrigating solution was 5 % mannitol injection. B was control group, irrigating solution was 5 % amylaceum injection. Combined spinal - epidural anesthesia or epidural anesthesia was used in the two groups. Venous blood were phlebotomized in order to detect serum natrium （Na^＋ ）, serum potassium（K^＋ ）, blood glucose（Glu）, haematoglobin （Hb） and Hct in T0,T30 and T60, MAP and Heart Rate was detected during operation. TURS incidence, OP time, irrigating solution dosage and transfusion dosage were recorded. Results It was not significant（ P 〉0.05）in MAP,HR,Na^＋ ,K＋ ,Glu,Hb,Hct of A group compare to preoperative. However it was significant （ P 〈 0.05） in MAP, Na^＋ , Hb, Hct of B group in T60, Glu was high in To and significant high（ P 〈0.01） in T60. In three time points, there were significant deviation（ P 〈0.05）about MAP,Hb,Hct in T60, there was more significant deviation（ P 〈 0.01）about Glu in Tr0.TURS was found in A group,four TURS in B group was 8 %. Conclusion 5 % mannitol injection as irrigating solution in TUVP can decrease absorption of irrigating solution and decrease TURS incidence in senile patients compared with 5 % amylaceum injection.