腰-硬联合麻醉下TUVP术中静脉滴注3％氯化钠溶液对预防TURS的临床意义

Clinical Significance of Intravenous Infusion of 3% Sodium Chloride Solution for Preventing TURS During TUVP with CSEA

【目的】分析在腰-硬联合麻醉（CSEA）下经尿道前列腺电汽化切除术（TUVP）术中静脉滴注3％氯化钠溶液对电解质的影响及对预防经尿道电切综合征（TURS）的临床意义。【方法】择期行TUVP术的良性前列腺增生（BPH）患者90例，随机分成三组，对照组（n=20）术中静脉滴注林格液（3mL／min），试验Ⅰ组（71—32）术中静滴林格液并管滴注3％氯化钠溶液（3～4mL／min），试验Ⅱ组（n=38）术中静滴林格液并管滴注3％氯化钠溶液（2mL／min）。手术均采用Wolf电切系统，手术时间均≥60min。观察并记录术前、术中30min、60min及术后电解质、血气、Hb、BUN、Hct等变化情况。【结果】血Na^＋在术中30min与术前比较无明显差异（P〉0．05），60min时却有显著降低（P〈0．05），术后与术前比较下降非常显著（P〈0．01）。血Na^＋下降幅度：试验Ⅰ组及试验Ⅱ纽在手术60min时显著低于对照组（P〈0．05）。【结论】TUVP术中运用静滴3％氯化钠溶液可降低低钠血症的发生，延缓严重低钠血症的发生，从而降低发生TURS的风险。

[Objective]To investigate the effect of intravenous infusion of 3% sodium chloride solution on electrolyte and its clinical significance for preventing transurethral resection syndrome（TURS） during transurethral electro-vaporization resection of the prostate （TUVP） with combined spinal epidural anesthesia （CSEA）. [Methods] Ninety patients with benign prostatic hyperplasia undergoing elective TUVP were randomly divided into three groups. The control group（ n = 20） received intraoperative intravenous infusion of Ringer＇s solution （3ml/min）. Group Ⅰ （ n =32） were treated with Ringer＇s solution and 3% sodium chloride solution （3-4 mL/min）. Group Ⅱ （ n =38） were treated Ringer＇s solution and 3 % sodium chloride solution （2ml/min） during operation. Wolf resectoscope system was used during operation and the operation time was ≥60min. The electrolyte, arterial blood gas, Hh, Bun, Hct and other changes before, during and after operation were recorded. [Results]There was no significant difference in blood Na^＋ between 30min in operation and before operation（ P 〉0.05）. Blood Na^＋ at 60min in operation decreased significantly（ P 〈0.05）, and there was significant difference between before and after operation（ P 〈0. 01）. The decreasing of blood Na^＋ at 60min in operation in Group Ⅰ and Group Ⅱ was obviously lower than that in control group（ P 〈0.05）. [Conclusion] Intravenous infusion of 3 % NaCl solution can reduce the incidence of hyponatremia and delay the occurrence of severe hyponatremia, and thus reduce the risk of TURS during TUVP.